- Email: [email protected]
174. Reliability and Reproducibility of SCIDS (Subaxial Cervical Injury Description System): A Standardized Nomenclature Schema
92S
Proceedings of the NASS 24th Annual Meeting / The Spine Journal 9 (2009) 1S–205S
174. Reliability and Reproducibility of SCIDS (Subaxial Cervical Injury Description System): A Standardized Nomenclature Schema Christopher Bono, MD1, Andrew Schoenfeld, MD1, Giri Gupta1, James Harrop, MD2, Paul Anderson, MD3, Alpesh Patel, MD5, John Dimar, II, MD6, Bizhan Arabi7, Andrew Dailey, MD4, Alexander Vaccaro, MD2, Ralf Gahr8; 1Brigham and Women’s Hospital, Boston, MA, USA; 2Thomas Jefferson University, Philadelphia, PA, USA; 3 University of Wisconsin-Madison, Madison, WI, USA; 4University of Utah, Salt Lake City, UT, USA; 5St Louis, MO, USA; 6University of Louisville, Louisville, KY, USA; 7University of Maryland, Baltimore, MD, USA; 8Germany BACKGROUND CONTEXT: Description of subaxial cervical injuries is critical for treatment decision-making and comparing scientific reports of outcomes. Despite a number of available classification systems, surgeons and researchers continue to use descriptive nomenclature, such as ‘‘burst’’ and ‘‘teardrop’’ fractures, to describe injuries. However, there is considerable inconsistency with use of such terms in the literature. Prompted by multiple cases of disagreement during review of prospectively collected clinical data from a multi-center database, the members of the Spine Trauma Study Group (STSG) developed a uniform nomenclatural list of common injury types called SCIDS (Subaxial Cervical Injury Description System). PURPOSE: To test the reliability and reproducibility of SCIDS STUDY DESIGN/SETTING: Radiographic measurement study PATIENT SAMPLE: Adult patients with various subaxial cervical injuries. OUTCOME MEASURES: Kappa statistic, percent agreement. METHODS: SCIDS is composed of 11 distinct injury types and associated definitions that were established by consensus by the members of the STSG. A series of 18 cases of patients with a broad spectrum of subaxial cervical spine injuries was prepared and distributed to surgeon raters. Each rater was provided with the full nomenclature document and asked to select primary and secondary injury types for each case. After receipt of the raters’ first round of classifications, the cases were resorted and returned to the raters for a second round of review. Interrater and intrarater reliabilities were calculated as percent agreement and Cohen’s kappa values. Intrarater reliability was assessed by comparing a given rater’s diagnosis from the first and second rounds. RESULTS: Overall agreement was 60.87% for the primary injury; kappa statistic was 0.485 (moderate agreement). The individual injury type with the highest agreement was lateral mass fracture (74.1%), while the injury with the lowest agreement was facet subluxation (7.7%). For some cases, however, there was 100% agreement among observers. For other cases, there was little agreement, with up to 4 different injury types selected for an individual case. CONCLUSIONS: The current study demonstrated that, even in ideal circumstances, there is only moderate agreement among raters regarding cervical injury nomenclature. It is hoped that more familiarity with the proposed SCIDS nomenclature will increase reproducibility in the future. Additional research is required to establish the clinical utility of this novel injury description schema. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.213
175. Survival of Atlanto-Occipital Dissociation Correlates with Injury Severity Score and Neurologic Status Christopher Chaput, MD1, Michael Hagen, BA2, Mathew Davis, MD1, Mark Rahm, MD2, David Ciceri, MD1; 1Scott & White Hospital, Texas A&M HSC, Temple, TX, USA; 2Texas A&M HSC, Temple, TX, USA BACKGROUND CONTEXT: Case reports and small case series suggest that Atlanto-Occipital Dissociation (AOD) is a potentially survivable injury. Some biomechanical and clinical studies suggest that AOD may
represent a larger spectrum of injuries than previously thought. Intuitively, a significant neurologic injury, a high degree of initial distraction, and more severe associated injuries would decrease the likelihood of survival. However, this has never been demonstrated for this injury pattern in a statistically meaningful way. PURPOSE: To compare the initial atlanto-occipital distraction, presence of a complete neurologic injury, and injury burden to the rate of survival in AOD. STUDY DESIGN/SETTING: Retrospective case series with radiographic and clinical review. PATIENT SAMPLE: All Patients Diagnosed with AOD at Level I trauma center in the past three years. OUTCOME MEASURES: Survival, ASIA standard neurological classification, Injury Severity Score (ISS). METHODS: 1140 patients in the Comprehensive 911 Trauma Database were reviewed from 2005-2008. 14 patients were found with a diagnosis of atlanto-occipital dissociation., The Basion-Dens Interval (BDI) was measured in millimeters on the sagittal CT reconstructions at the time of presentation. Neurologic status and injury severity score were available from the database. Fisher’s exact test was used to evaluate possible associations between survival and BDIO14 as well as the presence of a complete neurologic injury. ISS and survival status were compared using Wilcoxon’s test. RESULTS: Seven patients (50%) ultimately expired and all of these had complete, high cervical, spinal cord injuries (no evidence of diaphragmatic function or other motor function below the cranial nerves). Follow up for survivors ranged from 6 months to 2 years. Age and gender did not show an association with survival. Survival did not correlate with BDIO14 mm (p50.1026). However, no patient survived with a BDIO 16.0 mm. Mortality was associated with presence of a complete neurologic injury (p50.0006) and a higher ISS (p50.0117). CONCLUSIONS: AOD is a potentially survivable injury; however, there may be identifiable subsets of patients where the injury is so severe that treatment is unlikely to change the outcome. This is the first study to show that the ISS and the presence of a complete neurologic injury correlate with the survivability of this devastating injury. A larger case series would help to generalize the results. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.214
176. Assessment of Hepatic Inflammation after Spinal Cord Injury Using Intravital Microscopy Hans Hundt, BSC, MD1, Jennifer Fleming, PhD1, Abdel Lawendy, MD, FRCS(C)1, Kevin Gurr, MD, FRCS(C)2, Bailey Stewart, MD, FRCS(C)2, David Sanders, MD, FRCS(C)2, Greg Mcgarr, BSC1, Relka Bihari, MSC1, Amit Badhwar, PhD1, Christopher Bailey, MD, MSC, FRCS(C)2; 1Critical Illness, Lawson Health Research Institute, and Division of Orthopaedics, Dept. of Surgery, London Health Sciences Center, The Univ. of Western Ontario, London, Ontario, Canada; 2Division of Orthopaedics, Dept. of Surgery, London Health Sciences Center, The Univ. of Western Ontario, London, Ontario, Canada BACKGROUND CONTEXT: Recent studies have examined the systemic inflammation that occurs following spinal cord injury (SCI) (Gris et al. 2008). It is believed that this systemic inflammation plays a role in the respiratory, renal and hepatic morbidity of SCI patients, ultimately contributing to mortality post-injury. Evidence of this inflammatory response has been shown as early as two hours post SCI (Gris et al. 2008) Intravital microscopy is a powerful tool for assessing inflammation acutely and in ‘real-time’ (Brock et al. 1999). This tool would be useful for demonstrating the acuteness of a systemic inflammatory response post-SCI, and for assessing the degree of inflammation to different severities of SCI. PURPOSE: The liver has been shown to play a particularly important role in the initiation and progression of the early systemic inflammatory
Proceedings of the NASS 24th Annual Meeting / The Spine Journal 9 (2009) 1S–205S
174. Reliability and Reproducibility of SCIDS (Subaxial Cervical Injury Description System): A Standardized Nomenclature Schema Christopher Bono, MD1, Andrew Schoenfeld, MD1, Giri Gupta1, James Harrop, MD2, Paul Anderson, MD3, Alpesh Patel, MD5, John Dimar, II, MD6, Bizhan Arabi7, Andrew Dailey, MD4, Alexander Vaccaro, MD2, Ralf Gahr8; 1Brigham and Women’s Hospital, Boston, MA, USA; 2Thomas Jefferson University, Philadelphia, PA, USA; 3 University of Wisconsin-Madison, Madison, WI, USA; 4University of Utah, Salt Lake City, UT, USA; 5St Louis, MO, USA; 6University of Louisville, Louisville, KY, USA; 7University of Maryland, Baltimore, MD, USA; 8Germany BACKGROUND CONTEXT: Description of subaxial cervical injuries is critical for treatment decision-making and comparing scientific reports of outcomes. Despite a number of available classification systems, surgeons and researchers continue to use descriptive nomenclature, such as ‘‘burst’’ and ‘‘teardrop’’ fractures, to describe injuries. However, there is considerable inconsistency with use of such terms in the literature. Prompted by multiple cases of disagreement during review of prospectively collected clinical data from a multi-center database, the members of the Spine Trauma Study Group (STSG) developed a uniform nomenclatural list of common injury types called SCIDS (Subaxial Cervical Injury Description System). PURPOSE: To test the reliability and reproducibility of SCIDS STUDY DESIGN/SETTING: Radiographic measurement study PATIENT SAMPLE: Adult patients with various subaxial cervical injuries. OUTCOME MEASURES: Kappa statistic, percent agreement. METHODS: SCIDS is composed of 11 distinct injury types and associated definitions that were established by consensus by the members of the STSG. A series of 18 cases of patients with a broad spectrum of subaxial cervical spine injuries was prepared and distributed to surgeon raters. Each rater was provided with the full nomenclature document and asked to select primary and secondary injury types for each case. After receipt of the raters’ first round of classifications, the cases were resorted and returned to the raters for a second round of review. Interrater and intrarater reliabilities were calculated as percent agreement and Cohen’s kappa values. Intrarater reliability was assessed by comparing a given rater’s diagnosis from the first and second rounds. RESULTS: Overall agreement was 60.87% for the primary injury; kappa statistic was 0.485 (moderate agreement). The individual injury type with the highest agreement was lateral mass fracture (74.1%), while the injury with the lowest agreement was facet subluxation (7.7%). For some cases, however, there was 100% agreement among observers. For other cases, there was little agreement, with up to 4 different injury types selected for an individual case. CONCLUSIONS: The current study demonstrated that, even in ideal circumstances, there is only moderate agreement among raters regarding cervical injury nomenclature. It is hoped that more familiarity with the proposed SCIDS nomenclature will increase reproducibility in the future. Additional research is required to establish the clinical utility of this novel injury description schema. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.213
175. Survival of Atlanto-Occipital Dissociation Correlates with Injury Severity Score and Neurologic Status Christopher Chaput, MD1, Michael Hagen, BA2, Mathew Davis, MD1, Mark Rahm, MD2, David Ciceri, MD1; 1Scott & White Hospital, Texas A&M HSC, Temple, TX, USA; 2Texas A&M HSC, Temple, TX, USA BACKGROUND CONTEXT: Case reports and small case series suggest that Atlanto-Occipital Dissociation (AOD) is a potentially survivable injury. Some biomechanical and clinical studies suggest that AOD may
represent a larger spectrum of injuries than previously thought. Intuitively, a significant neurologic injury, a high degree of initial distraction, and more severe associated injuries would decrease the likelihood of survival. However, this has never been demonstrated for this injury pattern in a statistically meaningful way. PURPOSE: To compare the initial atlanto-occipital distraction, presence of a complete neurologic injury, and injury burden to the rate of survival in AOD. STUDY DESIGN/SETTING: Retrospective case series with radiographic and clinical review. PATIENT SAMPLE: All Patients Diagnosed with AOD at Level I trauma center in the past three years. OUTCOME MEASURES: Survival, ASIA standard neurological classification, Injury Severity Score (ISS). METHODS: 1140 patients in the Comprehensive 911 Trauma Database were reviewed from 2005-2008. 14 patients were found with a diagnosis of atlanto-occipital dissociation., The Basion-Dens Interval (BDI) was measured in millimeters on the sagittal CT reconstructions at the time of presentation. Neurologic status and injury severity score were available from the database. Fisher’s exact test was used to evaluate possible associations between survival and BDIO14 as well as the presence of a complete neurologic injury. ISS and survival status were compared using Wilcoxon’s test. RESULTS: Seven patients (50%) ultimately expired and all of these had complete, high cervical, spinal cord injuries (no evidence of diaphragmatic function or other motor function below the cranial nerves). Follow up for survivors ranged from 6 months to 2 years. Age and gender did not show an association with survival. Survival did not correlate with BDIO14 mm (p50.1026). However, no patient survived with a BDIO 16.0 mm. Mortality was associated with presence of a complete neurologic injury (p50.0006) and a higher ISS (p50.0117). CONCLUSIONS: AOD is a potentially survivable injury; however, there may be identifiable subsets of patients where the injury is so severe that treatment is unlikely to change the outcome. This is the first study to show that the ISS and the presence of a complete neurologic injury correlate with the survivability of this devastating injury. A larger case series would help to generalize the results. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.214
176. Assessment of Hepatic Inflammation after Spinal Cord Injury Using Intravital Microscopy Hans Hundt, BSC, MD1, Jennifer Fleming, PhD1, Abdel Lawendy, MD, FRCS(C)1, Kevin Gurr, MD, FRCS(C)2, Bailey Stewart, MD, FRCS(C)2, David Sanders, MD, FRCS(C)2, Greg Mcgarr, BSC1, Relka Bihari, MSC1, Amit Badhwar, PhD1, Christopher Bailey, MD, MSC, FRCS(C)2; 1Critical Illness, Lawson Health Research Institute, and Division of Orthopaedics, Dept. of Surgery, London Health Sciences Center, The Univ. of Western Ontario, London, Ontario, Canada; 2Division of Orthopaedics, Dept. of Surgery, London Health Sciences Center, The Univ. of Western Ontario, London, Ontario, Canada BACKGROUND CONTEXT: Recent studies have examined the systemic inflammation that occurs following spinal cord injury (SCI) (Gris et al. 2008). It is believed that this systemic inflammation plays a role in the respiratory, renal and hepatic morbidity of SCI patients, ultimately contributing to mortality post-injury. Evidence of this inflammatory response has been shown as early as two hours post SCI (Gris et al. 2008) Intravital microscopy is a powerful tool for assessing inflammation acutely and in ‘real-time’ (Brock et al. 1999). This tool would be useful for demonstrating the acuteness of a systemic inflammatory response post-SCI, and for assessing the degree of inflammation to different severities of SCI. PURPOSE: The liver has been shown to play a particularly important role in the initiation and progression of the early systemic inflammatory