Background: The Victorian Audit of Surgical Mortality (VASM) seeks to peer review all deaths associated with surgical care in Victoria, Australia. The effectiveness of the VASM as an educational and quality improvement tool is dependent on the accuracy of source data it receives. We aimed to examine the accuracy and quality of source data provided by the treating surgeon for peer review, and the inter-rater concordance level between the external validator findings and the treating surgeon. Methods: Of the 629 cases that completed the VASM audit second-line peer review process over a 4-year period (from 1 July 2012 to 30 June 2016), a total of 32 (5%) were randomly selected for the external validation process. The blinded external validator was impartial to the VASM audit, and was provided only de-identified patient medical records. The analysis for the checked and validated data points and their concordance was determined using Gwet's agreement coefficient, which provides a stable inter-rater reliability coefficient not affected by prevalence and marginal probability. Results: The inter-rater concordance analysis suggested that there is a high level of agreement (82.9% overall) between the treating surgeon and external validator. The use of thromboembolism deterrent stockings was the only variable where agreement was poor (52.4%) with a Gwet score of 0.10 (−0.40 to 0.60). Conclusion: The inter-rater concordance analysis results support the validity of the VASM process, which is dependent on the accuracy of data submitted by the treating surgeon.

Patellofemoral pain (PFP) is defined as retro‐ or peri‐patellar knee pain without a clear structural abnormality. Unfortunately, many current treatment approaches fail to provide long‐term pain relief, potentially due to an incomplete understanding of pain‐disrupted sensorimotor dysfunction within the central nervous system. The purposes of this study were to evaluate brain functional connectivity in participants with and without PFP, and to determine the relationship between altered brain functional connectivity in association with patient‐reported outcomes. Young female patients with PFP (n = 15; 14.3 ± 3.2 years) completed resting‐state functional magnetic resonance imaging (rs‐fMRI) and patient‐reported outcome measures. Each patient with PFP was matched with two controls (n = 30, 15.5 ± 1.4 years) who also completed identical rs‐fMRI testing. Six bilateral seeds important for pain and sensorimotor control were created, and seed‐to‐voxel analyses were conducted to compare functional connectivity between the two groups, as well as to determine the relationship between connectivity alterations and patient‐reported outcomes. Relative to controls, patients with PFP exhibited altered functional connectivity between regions important for pain, psychological functioning, and sensorimotor control, and the connectivity alterations were related to perceived disability, dysfunction, and kinesiophobia. The present results support emergent evidence that PFP is not localized to structural knee dysfunction, but may actually be resultant to altered central neural processes. Clinical significance: These data provide potential neuro‐therapeutic targets for novel therapies aimed to reorganize neural processes, improve neuromuscular function, and restore an active pain‐free lifestyle in young females with PFP.

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