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Kleinlugtenbelt YV, Hoekstra M, Ham SJ, et al. Spectrum bias, a common unrecognised issue in orthopaedic agreement studies: do CT scans really influence the agreement on treatment plans in fractures of the distal radius?. Bone Joint Res. 2015;4(12):190-4doi: 10.1302/2046-3758.412.2000433.
Kleinlugtenbelt, Y. V., Hoekstra, M., Ham, S. J., Kloen, P., Haverlag, R., Simons, M. P., Bhandari, M., Goslings, J. C., Poolman, R. W., & Scholtes, V. A. (2015). Spectrum bias, a common unrecognised issue in orthopaedic agreement studies: do CT scans really influence the agreement on treatment plans in fractures of the distal radius?. Bone & joint research, 4(12), 190-4. https://doi.org/10.1302/2046-3758.412.2000433
Kleinlugtenbelt, Y V, et al. "Spectrum bias, a common unrecognised issue in orthopaedic agreement studies: do CT scans really influence the agreement on treatment plans in fractures of the distal radius?." Bone & joint research vol. 4,12 (2015): 190-4. doi: https://doi.org/10.1302/2046-3758.412.2000433
Kleinlugtenbelt YV, Hoekstra M, Ham SJ, Kloen P, Haverlag R, Simons MP, Bhandari M, Goslings JC, Poolman RW, Scholtes VA. Spectrum bias, a common unrecognised issue in orthopaedic agreement studies: do CT scans really influence the agreement on treatment plans in fractures of the distal radius?. Bone Joint Res. 2015 Dec;4(12):190-4. doi: 10.1302/2046-3758.412.2000433. PMID: 26625876; PMCID: PMC5001195.
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Bone Joint Res. 2015 Dec;4(12):190-4. doi: 10.1302/2046-3758.412.2000433.

Spectrum bias, a common unrecognised issue in orthopaedic agreement studies: do CT scans really influence the agreement on treatment plans in fractures of the distal radius?.

Bone & joint research

Y V Kleinlugtenbelt, M Hoekstra, S J Ham, P Kloen, R Haverlag, M P Simons, M Bhandari, J C Goslings, R W Poolman, V A B Scholtes

Affiliations

  1. Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands.
  2. JointResearch Onze Lieve Vrouwe Gasthuis, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands.
  3. Academic Medical Centre, P.O. Box 22660, 1100, DD, Amsterdam, The Netherlands.
  4. McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Ontario, Canada.
  5. Academic Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.

PMID: 26625876 PMCID: PMC5001195 DOI: 10.1302/2046-3758.412.2000433

Abstract

OBJECTIVES: Current studies on the additional benefit of using computed tomography (CT) in order to evaluate the surgeons' agreement on treatment plans for fracture are inconsistent. This inconsistency can be explained by a methodological phenomenon called 'spectrum bias', defined as the bias inherent when investigators choose a population lacking therapeutic uncertainty for evaluation. The aim of the study is to determine the influence of spectrum bias on the intra-observer agreement of treatment plans for fractures of the distal radius.

METHODS: Four surgeons evaluated 51 patients with displaced fractures of the distal radius at four time points: T1 and T2: conventional radiographs; T3 and T4: radiographs and additional CT scan (radiograph and CT). Choice of treatment plan (operative or non-operative) and therapeutic certainty (five-point scale: very uncertain to very certain) were rated. To determine the influence of spectrum bias, the intra-observer agreement was analysed, using Kappa statistics, for each degree of therapeutic certainty.

RESULTS: In cases with high therapeutic certainty, intra-observer agreement based on radiograph was almost perfect (0.86 to 0.90), but decreased to moderate based on a radiograph and CT (0.47 to 0.60). In cases with high therapeutic uncertainty, intra-observer agreement was slight at best (-0.12 to 0.19), but increased to moderate based on the radiograph and CT (0.56 to 0.57).

CONCLUSION: Spectrum bias influenced the outcome of this agreement study on treatment plans. An additional CT scan improves the intra-observer agreement on treatment plans for a fracture of the distal radius only when there is therapeutic uncertainty. Reporting and analysing intra-observer agreement based on the surgeon's level of certainty is an appropriate method to minimise spectrum bias. Cite this article: Bone Joint Res 2015;4:190-194.

©2015 Kleinlugtenbelt et al.

Keywords: Agreement study; computed tomography; distal radial fracture; intraobserver; spectrum bias

Conflict of interest statement

ICMJE Conflict of Interest:None declared

References

  1. J Hand Surg Am. 2001 May;26(3):415-21 - PubMed
  2. Unfallchirurg. 2004 Jun;107(6):491-8 - PubMed
  3. ANZ J Surg. 2013 Sep;83(9):676-8 - PubMed
  4. J Hand Surg Am. 1997 Sep;22(5):792-800 - PubMed
  5. Am J Orthop (Belle Mead NJ). 2014 Mar;43(3):E43-7 - PubMed
  6. Injury. 2010 Feb;41(2):173-8 - PubMed
  7. J Shoulder Elbow Surg. 2012 Jun;21(6):772-6 - PubMed
  8. J Am Acad Orthop Surg. 2014 Sep;22(9):566-75 - PubMed
  9. J Bone Joint Surg Am. 2010 Nov 3;92 (15):2523-32 - PubMed
  10. J Orthop Trauma. 2002 Oct;16(9):632-7 - PubMed
  11. J Orthop Trauma. 1997 Oct;11(7):484-9 - PubMed
  12. J Orthop Surg Res. 2011 Jul 29;6:38 - PubMed
  13. N Engl J Med. 1978 Oct 26;299(17):926-30 - PubMed
  14. J Hand Surg Am. 1994 Sep;19(5):720-7 - PubMed
  15. Biometrics. 1977 Mar;33(1):159-74 - PubMed
  16. Emerg Radiol. 2011 Aug;18(4):279-83 - PubMed
  17. J Bone Joint Surg Am. 2009 May;91 Suppl 3:99-106 - PubMed

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