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OBJECTIVES: To analyze the inter-observer reliability of risk for venous thromboembolism (VTE) in a population of adult acutely-ill medical patients. METHODS: In this prospective cohort study, we collected risk factors and risk classification for VTE using RAM IMPROVE7. Kappa statistics was used to evaluate inter-observer reliability between lead clinicians and trained researchers. We evaluated occurrence of VTE in patients with mismatched classification. RESULTS: We included 2,380 patients, median age 70 years (interquartile range [IQR], 58-79), 56.2% female. Adjusted Kappa for VTE risk factors ranged from substantial (0.64, 95% confidence interval [CI], 0.61-0.67) for "immobilization", to almost perfect (0.98; 95% CI 0.97-0.99) for "thrombophilia"; risk classification was 0.64 (95% CI 0.60-0.67). Divergent risk classification occurred in 434 patients (18.2%) of whom seven (1.6%) developed VTE. CONCLUSION: Despite substantial to almost perfect reliability between observers for risk factors and risk classification, lead clinicians tended to underestimate the risk for VTE.

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BACKGROUND: There is controversy surrounding the reliability of radiographic measurements and existing classifications for proximal humeral fractures. METHODS: Ten orthopedists, divided into 2 groups by length of experience, evaluated radiographs in 3 views from 40 proximal humeral fractures. We evaluated 11 radiographic criteria (including the Neer and pathomorphologic classifications, head-shaft angle, displacement of the humeral shaft, and lesser and greater tuberosities) and treatment indication. We also analyzed the criteria that most influenced the choice of treatment. RESULTS: Interobserver reliability was substantial for the presence of fracture of the greater tuberosity (κ = 0.749) and medial metaphyseal comminution (κ = 0.627) and moderate for the pathomorphologic classification (κ = 0.504), displacement of the greater tuberosity (κ = 0.422), and treatment decision (κ = 0.565). Intraobserver reliability was substantial for treatment indication (κ = 0.620) and presence of displacement of the fracture of the greater tuberosity (κ = 0.627 and 0.611) and moderate for the Neer (κ = 0.490) and pathomorphologic (κ = 0.607) classifications. The results were influenced by the observer's experience. The surgical indication was influenced by the pathomorphologic classification in 50% of the evaluators (odds ratio, 4.85; range, 3.30-8.65). CONCLUSION: The pathomorphologic classification has higher reliability than the Neer classification and was the factor that most influenced the surgical decision. The determination of the presence of fracture and displacement of the greater tuberosity and medial metaphyseal comminution is reliable with the use of simple radiographs, and the results were influenced by the observer's experience.

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BACKGROUND: The most common methods for assessing severity of hallux valgus deformity and the effects of an operative procedure are the angular measurements in weightbearing radiographs, specifically the hallux valgus angle and intermetatarsal angle (IMA). Our objective was to analyze the interobserver variability in hallux valgus patients of a new angle called the "angle to be corrected" (ATC), and to compare its capacity to differentiate between different deformities against IMA. METHODS: We included 28 symptomatic hallux valgus patients with 48 weightbearing foot x-rays. Three trained observers measured the 1 to 2 IMA and the ATC. We then identified retrospectively 45 hallux valgus patients, which were divided into 3 operative technique groups having used the ATC as reference, and analyzed the capacity of the IMA to differentiate between them. RESULTS: The IMA average value was 13.6 degrees, and there was a significant difference between observer 3 and observer 1 (P = .001). The average value for the ATC was 8.9 degrees, and there was no difference between observers. Both angles showed a high intraclass correlation. Regarding the capacity to differentiate between operative technique groups, the ATC was different between the 3 operative technique groups analyzed, but the IMA showed differences only between 2. CONCLUSIONS: The ATC was at least as reliable as the intermetatarsal angle for hallux valgus angular measurements, showing a high intraclass correlation with no interobserver difference. It can be suggested that the ATC was better than the IMA to stratify hallux valgus patients when deciding between different operative treatments. LEVEL OF EVIDENCE: Level III, comparative study.

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Introducción: El objetivo de este trabajo fue analizar la reproducibilidad intra e interobservador de la clasificación de lesiones meniscales de Sociedad Internacional de Artroscopía, Cirugía de la Rodilla y Medicina Deportiva (ISAKOS). Materiales y Métodos: Se utilizó la clasificación artroscópica de lesiones meniscales creada por la ISAKOS. Se seleccionaron y se analizaron 31 videos artroscópicos de cirugías realizadas en el Hospital Italiano de Buenos Aires. Los mismos fueron evaluados por 3 traumatólogos (2 especialistas en cirugía de rodilla y un becario de postgrado), en dos ocasiones con un intervalo de 30 días. Se utilizó el índice de Kappa de Cohen para evaluar la reproducibilidad intraobservador y el coeficiente de correlación intraclase para la reproducibilidad interobservador. Resultados: La reproductibilidad promedio intraobservador fue para el primero de 51%, para el segundo de 65% y para el tercero de 58%, alcanzando un acuerdo moderado según la categorización del coeficiente de Kappa utilizada por Landis y Koch. Con respecto a la reproductibilidad interobservador, se obtuvo una concordancia buena (ICC=0,71), según el Coeficiente de correlación intraclase. Todos los cálculos fueron estadisticamente significativos. (p<0,05). Conclusión: Si bien esta clasificación permite una detallada descripción de las lesiones meniscales, la reproductibilidad intraobservador no alcanzo los valores óptimos a pesar de haber obtenido en promedio un acuerdo moderado. Por otro lado, la reproductibilidad interobservador demostró en promedio resultados mayores al 70% (concordancia buena), con lo cual podemos afirmar que el acuerdo y reproductibilidad interobservador es aceptable. Tipo de trabajo: Observacional, descriptivo de tipo diagnóstico. Nivel de Evidencia: IV

Objectives: To analyze the intra and interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification for meniscal tears. Methods: The arthroscopic classification for meniscal lesions created by the ISAKOS was used. Thirty-one arthroscopic videos with different meniscal tear characteristics were analyzed by three orthopedic surgeons (two specialists in knee surgery and a fellow), twice at an interval of 30 days. The Kappa Coefficients (k) was used to assess the intraobserver reliability and intraclass correlation coefficient (ICC) for interobserver reliability. Results: The average intraobserver reliability was 51% for the first observer, 65% for the second and 58% for the third, reaching moderate agreement according to the Kappa coefficient used by Landis and Koch. Regarding interobserver reliability, good agreement (ICC = 0.71) was obtained for the intraclass correlation coefficient. The whole results were statistically significant (p <0.05). Conclusion: While this classification provides a detailed description of meniscal lesions, the intraobserver reliability did not reach the optimum values obtained despite having on average a moderate agreement. However interobserver reliability showed on average agreement of 70% (good agreement), which can affirm that the agreement and interobserver reliability is acceptable. Type of Study: Observational, descriptive, a diagnostic study. Level Of Evidence: IV

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Avaliou-se a confiabilidade interobservador da Classificação Internacional de Atenção Primária na codificação de queixas relatadas em unidade básica de saúde pública, por meio de uma amostra de 300 atendimentos. Os motivos de consulta foram registrados por médicos do serviço, e sua codificação realizada por duas pesquisadoras. A concordância entre as classificadoras em relação ao número de motivos codificados foi calculada por meio do kappa ponderado; para as demais análises (capítulos e códigos completos), foi utilizado o coeficiente kappa simples. Foram codificados 634 motivos pela primeira classificadora e 699 pela segunda. A concordância simples do número de motivos foi moderada, com kappa ponderado de 0,71 (Intervalo de 95% de Confiança [IC95%]: 0,68-0,73). Em relação aos códigos de capítulos e códigos completos, foram encontradas confiabilidade substancial (kappa = 0,89; IC95%: 0,87-0,91) e moderada (kappa = 0,72; IC95%: 0,68-0,76), respectivamente. Os resultados indicam bom desempenho da classificação para codificar motivos de atendimento na atenção básica, mesmo a partir de registros médicos.

We evaluated the International Classification of Primary Care interobserver reliability for coding the complaints reported at a primary public health unit. The study sample consisted of 300 appointments. Reasons for appointment were registered by physicians on the medical record and coding was performed by two investigators. Reliability among the classifiers as to the number of coded reasons was calculated by weighted kappa. Crude kappa coefficients were used for the remaining analyses (chapter codes and full codes). A total of 634 reasons were coded by the first classifier and 699 by the second one. Crude reliability of numbers of reasons was moderate, with a 0.71 weighted kappa (95% Confidence Interval [95%CI]: 0.68-0.73). Regarding chapter codes and full codes, reliability was substantial (kappa = 0.89; 95%CI: 0.87-0.91) and moderate (kappa = 0.72; 95% CI: 0.68-0.76), respectively. Our results suggest a good performance of the Classification for coding reasons for visit in primary care, even when data are obtained from physician consultation notes.

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