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首页> 外文OA文献 >Spectrum bias, a common unrecognised issue in orthopaedic agreement studies DO CT SCANS REALLY INFLUENCE THE AGREEMENT ON TREATMENT PLANS IN FRACTURES OF THE DISTAL RADIUS?
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Spectrum bias, a common unrecognised issue in orthopaedic agreement studies DO CT SCANS REALLY INFLUENCE THE AGREEMENT ON TREATMENT PLANS IN FRACTURES OF THE DISTAL RADIUS?

机译：频谱偏差是骨科协议研究中一个常见的无法识别的问题，CT CT真正影响了对远端RADIUS骨折治疗计划的协议吗？

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Objectives Current studies on the additional benefit of using computed tomography (CT) in order to evaluate the surgeons' agreement on treatment plans for fracture are inconsistent. This inconsistency can be explained by a methodological phenomenon called 'spectrum bias', defined as the bias inherent when investigators choose a population lacking therapeutic uncertainty for evaluation. The aim of the study is to determine the influence of spectrum bias on the intra-observer agreement of treatment plans for fractures of the distal radius. Methods Four surgeons evaluated 51 patients with displaced fractures of the distal radius at four time points: T1 and T2: conventional radiographs; T3 and T4: radiographs and additional CT scan (radiograph and CT). Choice of treatment plan (operative or non-operative) and therapeutic certainty (five-point scale: very uncertain to very certain) were rated. To determine the influence of spectrum bias, the intra-observer agreement was analysed, using Kappa statistics, for each degree of therapeutic certainty. Results In cases with high therapeutic certainty, intra-observer agreement based on radiograph was almost perfect (0.86 to 0.90), but decreased to moderate based on a radiograph and CT (0.47 to 0.60). In cases with high therapeutic uncertainty, intra-observer agreement was slight at best (-0.12 to 0.19), but increased to moderate based on the radiograph and CT (0.56 to 0.57). Conclusion Spectrum bias influenced the outcome of this agreement study on treatment plans. An additional CT scan improves the intra-observer agreement on treatment plans for a fracture of the distal radius only when there is therapeutic uncertainty. Reporting and analysing intra-observer agreement based on the surgeon's level of certainty is an appropriate method to minimise spectrum bias
机译：目的目前有关使用计算机断层扫描（CT）评估外科医生对骨折治疗计划的一致意见的研究不一致。这种不一致性可以通过一种称为“频谱偏倚”的方法学现象来解释，这种现象被定义为调查人员选择缺乏治疗不确定性的人群进行评估时所固有的偏倚。该研究的目的是确定频谱偏差对on骨远端骨折治疗计划的观察者内协议的影响。方法4位外科医生在4个时间点对51例radius骨远端移位骨折患者进行了评估： T3和T4：X射线照片和其他CT扫描（X射线照片和CT）。评价了治疗计划（手术或非手术）和治疗确定性（五点量表：非常不确定至非常确定）的选择。为了确定频谱偏差的影响，使用Kappa统计数据对每种治疗确定性进行了观察者内部协议分析。结果在具有较高治疗确定性的情况下，基于放射线照相的观察者内部一致性几乎是完美的（0.86至0.90），但根据放射线照相和CT的观察者内部一致性降至0.47至0.60。在治疗不确定性较高的情况下，观察者内部的一致性至多为轻微（-0.12至0.19），但根据X射线照片和CT观察，其一致性增至中度（0.56至0.57）。结论频谱偏差影响了该治疗方案协议研究的结果。仅当存在治疗不确定性时，额外的CT扫描才能改善观察者内部就远端on骨骨折的治疗计划达成的协议。根据外科医生的确定性水平来报告和分析观察者内部协议是使频谱偏差最小化的适当方法

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