Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2012 Jul;470(7):2029-34.
doi: 10.1007/s11999-012-2260-4.

Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement

Geert A Buijze  1 , Thierry G Guitton, C Niek van Dijk, David Ring; Science of Variation Group
Collaborators, Affiliations
Randomized Controlled Trial

Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement

Geert A Buijze et al. Clin Orthop Relat Res. 2012 Jul.

Abstract

Background: The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability.

Questions/purposes: We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans.

Methods: Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel's multirater kappa and the Z-test was used to test for significance.

Results: There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of scaphoid fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups.

Conclusions: Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of scaphoid fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.

PubMed Disclaimer

Figures

Fig. 1A–C
Fig. 1A–C
Diagrams from the training module illustrate (A) gapping, (B) angulation, and (C) translation in a displaced fracture.
See this image and copyright information in PMC

References

    1. Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney WP, 3rd, Linscheid RL. Scaphoid malunion. J Hand Surg Am. 1989;14:679–687. doi: 10.1016/0363-5023(89)90191-3. - DOI - PubMed
    1. Bain GI, Bennett JD, MacDermid JC, Slethaug GP, Richards RS, Roth JH. Measurement of the scaphoid humpback deformity using longitudinal computed tomography: intra- and interobserver variability using various measurement techniques. J Hand Surg Am. 1998;23:76–81. doi: 10.1016/S0363-5023(98)80093-2. - DOI - PubMed
    1. Bankier AA, Fleischmann D, Maertelaer V, Kontrus M, Zontsich T, Hittmair K, Mallek R. Subjective differentiation of normal and pathological bronchi on thin-section CT: impact of observer training. Eur Respir J. 1999;13:781–786. doi: 10.1034/j.1399-3003.1999.13d14.x. - DOI - PubMed
    1. Berg WA, D’Orsi CJ, Jackson VP, Bassett LW, Beam CA, Lewis RS, Crewson PE. Does training in the Breast Imaging Reporting and Data System (BI-RADS) improve biopsy recommendations or feature analysis agreement with experienced breast imagers at mammography? Radiology. 2002;224:871–880. doi: 10.1148/radiol.2243011626. - DOI - PubMed
    1. Bernard SA, Murray PM, Heckman MG. Validity of conventional radiography in determining scaphoid waist fracture displacement. J Orthop Trauma. 2010;24:448–451. doi: 10.1097/BOT.0b013e3181c3e865. - DOI - PubMed

Publication types