Validity and reliability of a method for assessment of cervical vertebral maturation

Abstract

Objective: To evaluate the validity and reliability of the cervical vertebral maturation (CVM) method with a longitudinal sample. Materials and Methods: Eighty-six cephalograms from 18 subjects (5 males and 13 females) were selected from the longitudinal database. Total mandibular length was measured on each film; an increased rate served as the gold standard in examination of the validity of the CVM method. Eleven orthodontists, after receiving intensive training in the CVM method, evaluated all films twice. Kendall's W and the weighted kappa statistic were employed. Results: Kendall's W values were higher than 0.8 at both times, indicating strong interobserver reproducibility, but interobserver agreement was documented twice at less than 50%. A wide range of intraobserver agreement was noted (40.7%-79.1%), and substantial intraobserver reproducibility was proved by kappa values (0.53-0.86). With regard to validity, moderate agreement was reported between the gold standard and observer staging at the initial time (kappa values 0.44-0.61). However, agreement seemed to be unacceptable for clinical use, especially in cervical stage 3 (26.8%). Conclusions: Even though the validity and reliability of the CVM method proved statistically acceptable, we suggest that many other growth indicators should be taken into consideration in evaluating adolescent skeletal maturation. (Angle Orthod. 2012;82:229-234.)

Does clinical experience affect the reproducibility of cervical vertebrae maturation method?

“…In Zhao et al, 31 the CVMM was explained to the observers by means of training sessions, and it showed values of W and k coefficients similar to our best performing sample (JU). Hence, to correctly use the CVMM there might be a need for multiple training sessions to understand how to assess the cervical stage and to acquire a consistent method of evaluation.…”

“…20 Some authors have succeeded in the investigation of the reproducibility overcoming the previous methodologic weakness but without exploring the influence of clinical experience on the reproducibility of the CVMM. 20,30,31,34 Indeed, there is little information about the impact of judges' clinical experience on the CVMM, even though it should not be underestimated. 20,35 Therefore, the aim of this study was to evaluate the interobserver and intraobserver reproducibility of the CVMM among three judge panels with different levels of orthodontic experience (OE).…”

“…20 Different investigations have studied the association between the CVMM and skeletal maturity and the CVMM and mandibular growth spurt, testing the validity. [21][22][23][24][25][26][27][28][29][30][31] Several studies found a good correlation between CVMM and HWBA, suggesting the possibility to use the CVMM instead of the HWBA to reduce the radiation dose. [21][22][23][24][25][26] However, a recent systematic review of the CVMM was not able to establish the validity of this method due to the lack of moderate/high quality papers on this topic.…”

Lateral comparisons using Fishman's skeletal maturation assessment

“…While some studies have noted a disadvantage in exposing a radiograph of the hand-wrist area and advocate the use of cervical vertebrae maturation staging from an existing lateral cephalogram, 10,11 others have questioned the reliability of the latter. 12,13 Our clinic has found that hand-wrist radiographs are easily implemented, simple to evaluate, and a valuable adjunct to our diagnostic workup.…”

La radiografía cefálica: más allá de una medida cefalométrica

“…Debido a que existen factores que afectan la precisión y reproducibilidad del método cvm -como son las mediciones subjetivas del clínico, las formas de las vértebras cervicales que tienen marcadas variaciones de un sujeto a otro, y la calidad de la radiografía-, es preferible correlacionarlo con otros indicadores de crecimiento en la evaluación de la maduración del esqueleto antes de tomar decisiones [31].…”