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
. 2012 Jul;73(1):224-31.
doi: 10.1097/TA.0b013e31824cf0ab.

How reliable and accurate is the AO/OTA comprehensive classification for adult long-bone fractures?

Terje Meling  1 , Knut Harboe, Cathrine H Enoksen, Morten Aarflot, Astvaldur J Arthursson, Kjetil Søreide
Affiliations

How reliable and accurate is the AO/OTA comprehensive classification for adult long-bone fractures?

Terje Meling et al. J Trauma Acute Care Surg. 2012 Jul.

Abstract

Background: Reliable classification of fractures is important for treatment allocation and study comparisons. The overall accuracy of scoring applied to a general population of fractures is little known. This study aimed to investigate the accuracy and reliability of the comprehensive Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association classification for adult long-bone fractures and identify factors associated with poor coding agreement.

Methods: Adults (>16 years) with long-bone fractures coded in a Fracture and Dislocation Registry at the Stavanger University Hospital during the fiscal year 2008 were included. An unblinded reference code dataset was generated for the overall accuracy assessment by two experienced orthopedic trauma surgeons. Blinded analysis of intrarater reliability was performed by rescoring and of interrater reliability by recoding of a randomly selected fracture sample. Proportion of agreement (PA) and kappa (κ) statistics are presented. Uni- and multivariate logistic regression analyses of factors predicting accuracy were performed.

Results: During the study period, 949 fractures were included and coded by 26 surgeons. For the intrarater analysis, overall agreements were κ = 0.67 (95% confidence interval [CI]: 0.64-0.70) and PA 69%. For interrater assessment, κ = 0.67 (95% CI: 0.62-0.72) and PA 69%. The accuracy of surgeons' blinded recoding was κ = 0.68 (95% CI: 0.65- 0.71) and PA 68%. Fracture type, frequency of the fracture, and segment fractured significantly influenced accuracy whereas the coder's experience did not.

Conclusions: Both the reliability and accuracy of the comprehensive Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association classification for long-bone fractures ranged from substantial to excellent. Variations in coding accuracy seem to be related more to the fracture itself than the surgeon.

Level of evidence: Diagnostic study, level I.

PubMed Disclaimer

Publication types