title: Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study.
abstract: The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries.
  
  
  
  Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6 weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation.
  
  
  
  Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k = 0.43 ± 0.01 and 0.59 ± 0.16, respectively, PLC: k = 0.47 ± 0.01 and 0.55 ± 0.15, respectively), and fair to moderate reliability (k = 0.29 ± 0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k = 0.59 ± 0.01) and substantial intrarater reliability (k = 0.68 ± 0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems.
  
  
  
  Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not only their reliability and reproducibility, but also the other attributes, especially the clinical significance of a good classification system.
authors.affiliation: Department of Orthopedics, Flt. Lt. Rajan Dhal, Fortis Hospital, Vasant Kunj, New Delhi, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kaul
authors.affiliation: Indian Spinal Injuries Center, Sector C, Vasant Kunj, New Delhi, India. drhschhabra@isiconline.org.
authors.forename: Harvinder Singh
authors.initials: HS
authors.lastname: Chhabra
authors.affiliation: Department of Orthopaedic Surgery, Delaware Valley Spinal Cord Injury Center, Rothman Institute, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.affiliation: Klinik für Querschnittgelähmte, Orthopädie und Rheumatologie, Klinik Hohe Warte, Klinikum Bayreuth GmbH, Bayreuth, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Abel
authors.affiliation: Florida Spinal Surgery Center, Miami, FL, USA.
authors.forename: Sagun
authors.initials: S
authors.lastname: Tuli
authors.affiliation: Division of Orthopaedics, Trauma and Spine Surgery, Ganga Hospital, Coimbatore, India.
authors.forename: Ajoy Prasad
authors.initials: AP
authors.lastname: Shetty
authors.affiliation: Indian Spinal Injuries Center, Sector C, Vasant Kunj, New Delhi, India.
authors.forename: Kali Dutta
authors.initials: KD
authors.lastname: Das
authors.affiliation: Indian Spinal Injuries Center, Sector C, Vasant Kunj, New Delhi, India.
authors.forename: Bibhudendu
authors.initials: B
authors.lastname: Mohapatra
authors.affiliation: Indian Spinal Injuries Center, Sector C, Vasant Kunj, New Delhi, India.
authors.forename: Ankur
authors.initials: A
authors.lastname: Nanda
authors.affiliation: Indian Spinal Injuries Center, Sector C, Vasant Kunj, New Delhi, India.
authors.forename: Gururaj M
authors.initials: GM
authors.lastname: Sangondimath
authors.affiliation: Indian Spinal Injuries Center, Sector C, Vasant Kunj, New Delhi, India.
authors.forename: Murari Lal
authors.initials: ML
authors.lastname: Bansal
authors.affiliation: Indian Spinal Injuries Center, Sector C, Vasant Kunj, New Delhi, India.
authors.forename: Nishit
authors.initials: N
authors.lastname: Patel
mesh_terms: D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000293:injuries*; D011897:Random Allocation; D015203:Reproducibility of Results; D013124:Spinal Injuries / Q000145:classification*; D013904:Thoracic Vertebrae / Q000293:injuries*
keywords: AOSpine Thoracolumbar Spine Injury Classification System; Reliability; TLICS; Thoracolumbar spine injuries