Intra/interobserver agreement of proximal humeral fracture classification systems
DOI:
https://doi.org/10.15343/0104-7809.202650e19382025PKeywords:
Fractures, Radiography, Humerus, Interobserver, IntraobserverAbstract
This study assessed the inter- and intraobserver agreement of the NEER, LEGO/HERTEL, AO/OTA, and MAYO-FJD classification systems for proximal humeral fractures. Five evaluators — a first-year resident (R1), a second-year resident (R2), a third-year resident (R3), an orthopedic surgeon (Ortho), and a shoulder surgery specialist (Spec.) – assessed 50 radiographs of patients with proximal humeral fractures at two time points (T1 and T2). Cohen’s and Fleiss’s Kappa coefficients were used for statistical analysis. Regarding interobserver agreement, the NEER system at T1 and T2 (κ=0.444 and κ=0.496) demonstrated moderate agreement. The LEGO/HERTEL system at T1 and T2 (κ=0.376 and κ=0.387), the AO/OTA system at T1 and T2 (κ=0.269 and κ=0.223), and the MAYO-FJD system at T1 and T2 (κ=0.367 and κ=0.300) demonstrated low agreement. Moderate intraobserver agreement was observed for the NEER system. The LEGO/ HERTEL system showed substantial agreement with κ=0.528 (R1) and near-perfect agreement with κ=0.867 (Spec.). For the AO/OTA system, Kappa values ranged from 0.347 (R1) to 0.793 (R3), oscillating between low and substantial. The MAYO-FJD system presented the lowest agreement (κ=0.154 [R1] to κ=0.665 [Spec.]). It is concluded that regarding interobserver agreement, the NEER system achieved a moderate result. Regarding intraobserver agreement, more experienced evaluators demonstrated greater consistency compared to residents.
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