Substantial accuracy of fracture classification in the Swedish Fracture Register: Evaluation of AO/OTA-classification in 152 ankle fractures

Juto, Hans; Möller, Michael; Wennergren, David; Edin, Klas; Apelqvist, Ida; Morberg, Per

doi:10.1016/j.injury.2016.05.028

Cited by 42 publications

(36 citation statements)

References 10 publications

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“…In the SFR, fractures are classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/ Orthopaedic Trauma Association (AO/OTA) classification system [23]. Several studies have shown that this data has a high accuracy and validity [24][25][26][27]. The total number of orthopaedic departments in Sweden is 54.…”

Section: Study Population and Data Collectionmentioning

confidence: 99%

Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register

Rundgren

Bojan

Navarro

et al. 2020

BMC Musculoskelet Disord

154

122

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Background: Distal radius fractures are the most common of all fractures. Optimal treatment is still debated. Previous studies report substantial changes in treatment trends in recent decades. Few nationwide studies on distal radius fracture epidemiology and treatment exist, none of which provide detailed data on patient and injury characteristics, fracture pattern and mortality. The aim of this study was to describe the epidemiology, fracture classification, current treatment regimens and mortality of distal radius fractures in adults within the context of a large national register study. Methods: We performed a descriptive study using prospectively registered data from the Swedish fracture register. Included were all non-pathological distal radius fractures registered between January 1st 2015 and December 31st 2017 in patients aged 18 years and above. Nominal variables were presented as proportions of all registered fractures. Results: A total of 23,394 distal radius fractures in 22,962 patients were identified. The mean age was 62.7 ± 17.6 years for all, 65.4 ± 16.0 for women and 53.6 ± 20.0 for men. A simple fall was the most common cause of injury (75%, n = 17,643/23,394). One third (33%, n = 7783/21,723) of all fractures occurred at the patients' residence. 65% (n = 15,178/23,394) of all fractures were classified as extra-articular AO-23-A, 12% (n = 2770/23,394) as partially intraarticular AO-23-B and 23% (n = 5446/23,394) as intra-articular AO-23-C. The primary treatment was non-surgical for 74% (n = 17,358/23,369) and surgical for 26% (n = 6011/23,369) of all fractures. Only 18% of the AO-23-A fractures were treated surgically, compared to 48% of the AO-23-C fractures. The most frequently used surgical method was plate fixation (82%, n = 4954/5972), followed by pin/wire fixation (8.2%, n = 490/5972), external fixation (4.8%, n = 289/5972) and other methods (4.0%, n = 239/5972). The overall 30-day mortality was 0.4% (n = 98/23,394) and the 1-year mortality 2.9% (n = 679/23,394). Conclusion: This nationwide observational study provides comprehensive data on the epidemiology, fracture classification and current treatment regimens of distal radius fractures in a western European setting. The most common patient was an eldery woman who sustained a distal radius fracture through a simple fall in her own residence, and whose fracture was extra-articluar and treated non-surgically.

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Section: Study Population and Data Collectionmentioning

confidence: 99%

Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register

Rundgren

Bojan

Navarro

et al. 2020

BMC Musculoskelet Disord

154

122

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“…Na literatura encontramos trabalhos que avaliaram a variação na classificação intra e entre observadores das fraturas de tornozelo. Todos os estudos encontrados utilizaram o coeficiente Kappa para a análise da concordância, mostrando-se o mais confiável para se fazer a pesquisa (18)(19)(20)(21)(22)(23) . Na literatura brasileira foram encontrados quatro estudos que fizeram uma análise semelhante (7,12,24,25) .…”

Section: Discussionunclassified

Concordance analysis of adult ankle fracture classifications

et al. 2019

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Objective: To analyze the interobserver agreement among physicians in an orthopedy and traumatology service with knowledge and training in adult ankle fracture classifications through radiographic evaluation. Methods: A cross-sectional study was carried out in which the records of 20 patients with a diagnosis of ankle fracture in 2016 (uni-, bi- or trimalleolar), aged older than 18 years or with a closed physis, were studied. The radiographs that met the criteria were analyzed and classified according to the Danis Weber (DW), Lauge-Hansen (LH) and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classifications by two first-year residents, two second-year residents, two third-year residents and two preceptors of the service. The conditions were identical for the observers and were performed individually once. The Kappa coefficient (K) was used to assess agreement. Results: The results showed great interobserver agreement in the DW and LH classifications, with K values equal to 0.69 and 0.64, respectively. The AO/OTA classification showed moderate agreement, with K = 0.47. Conclusion: The DW classification was the most reliable among the three classifications. The AO/OTA classification showed the lowest agreement and was the least reliable, and the LH classification was in between the others. Level of Evidence III, Diagnostic Studies; Study of non consecutive patients; without consistently applied reference “gold” standard.

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“…Initially, an extensive literature research was conducted, using PubMed 3 , MEDLINE, Google Established registries used varying methods to evaluate their data quality, ranging from reproducibility of entered data sheets on cases 16 , completeness and correctness of registered procedures and diagnoses 8,13,18 up to plausibility of entered datasets 5 . No two registries had entirely matching approaches to data validation and no standardized systematic using transparent and reproducible methods could be identified.…”

Section: Finding a Methods For Data Quality Assessmentmentioning

confidence: 99%

Validating a transnational fracture treatment registry using a standardized method

Frese

Gode

Heinrichs

et al. 2019

Preprint

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Aim Subsequent to a three-month pilot phase, recruiting patients for the newly established BFCC (Baltic Fracture Competence Centre) transnational fracture registry, a validation of the data quality needed to be carried out, applying a standardized method.Method During the literature research, the method of “adaptive monitoring” fulfilled the requirements of the registry and was applied. It consisted of a three-step audit process; firstly, scoring of the overall data quality, followed by source data verification of a sample size, relative to the scoring result, and finally, feedback to the registry on measures to improve data quality. Statistical methods for scoring of data quality and visualisation of discrepancies between registry data and source data were developed and applied.Results Initially, the data quality of the registry scored as medium. During source data verification, missing items in the registry, causing medium data quality, turned out to be absent in the source as well. A subsequent adaptation of the score evaluated the registry’s data quality as good. It was suggested to add variables to some items in order to improve the accuracy of the registry.Discussion The application of the method of adaptive monitoring has only been published by Jacke et al., with a similar improvement of the scoring result following the audit process. Displaying data from the registry in graphs helped to find missing items and discover issues with data formats. Graphically comparing the degree of agreement between the registry and source data allowed to discover systematic faults.Conclusions The method of adaptive monitoring gives a substantiated guideline for systematically evaluating and monitoring a registry’s data quality and is currently second to none. The resulting transparency of the registry’s data quality could be helpful in annual reports, as published by most major registries. As the method has been rarely applied, further successive applications in established registries would be desirable.

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Substantial accuracy of fracture classification in the Swedish Fracture Register: Evaluation of AO/OTA-classification in 152 ankle fractures

Abstract: The study results show substantial agreement between classifications made in the SFR and gold standard classification. The finding is equivalent to or higher than in previous studies. Consequently, we conclude that classifications of ankle fractures in the SFR are accurate and valid.

Cited by 42 publications

References 10 publications

Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register

Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register

Concordance analysis of adult ankle fracture classifications

Validating a transnational fracture treatment registry using a standardized method

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