Inter- and intra-observer agreement of the Milch and Weiss classification systems in pediatric fractures of the lateral humeral condyle

SERGIO CHARLES LOZOYA

Resumo


Objective. The aim of this study is to estimate the inter- and intra-observer agreement of the Weiss and Milch classification systems in radiological studies of fractures of the lateral humeral condyle in pediatric patients. Methods. An agreement study was performed with non-probability sampling of consecutive cases with a sample size of a hundred radiological studies, which were evaluated by three experienced orthopedic surgeons and three resident physicians; following a thorough comparison of both inter- and intra-observer agreements during six weeks based on the Fleiss' kappa index, which was used to determine the inter- and intra-observer agreement rates of both classifications. Results: The overall reliability of the entire group of evaluators for the Milch classification in the inter-observer evaluation was κ = 0.13, 95% CI 0.08−0.18, and the intra-observer evaluation was κ = 0.08, 95% CI 0.06−0.11. As for the Weiss classification, the overall evaluation had an inter-observer agreement of κ = 0.53, 95% CI 0.50−0.57, and an intra-observer agreement of κ = 0.22, 95% CI 0.20−0.24. Conclusions: In the present study, the Weiss classification system demonstrated greater agreement than the Milch classification; however, the latter may require the use of complementary studies such as an arthrography to enhance classification accuracy. Level of Evidence II, Diagnostic Studies – Investigating Diagnostic Examination.
Key words: Pediatric, lateral condyle fractures, agreement study, kappa index.



Atha Comunicação e Editora Ltda Rua Machado Bittencourt, 190 conj. 410 CEP: 04044-903 Vila Clementino Tel.: 5579-5308/ 5087-9502