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Title: Complication Severity Score for Growth-Friendly Surgery Has Strong Inter-rater and Intra-rater Agreement

Authors: Michael N, Pan Z, Smith JT, Palmer C, St. Hilaire T, Morgan J, Heagy V, Children’s Spine Study Group, Garg S

Journal: J PediatrOrthop.38(4)

Date: April 01, 2018

Excerpt: Growth-friendly spine surgeries have increased significantly in the treatment of early onset scoliosis. Complications are common with these devices and are commonly reported on in research studies

Keywords: Growth-Friendly Spine Surgery, Complication Classification System, Reliability Study

Summary:

What is the purpose of this study?

Growth-friendly spine surgeries have increased significantly in the treatment of early onset scoliosis. Complications are common with these devices and are commonly reported on in research studies, but they are typically classified as "minor" or "major". Recently, a classification system was created and evaluted to better categorize and grade complications. The purpose of this study is to see if the new system is easy to use amongst a variety of different users and also be used consistently.

To do this, a survery was created where surgeons and researchers reviewed patient's cases and then classified each patient's complication severity and grade using the new classification system.

  • 63 cases with growth-friendly devices, who experienced complications, were randomly selected.
  • 10 of which experienced more than 10 complications.
  • Surgeons and research corrdinators looked at the 63 cases from two pediatric hospitals and their complications and completed the survey, designating the complications acorrding to the classification system.
  • The survey was administered a second time three weeks later to see if the responses would be in agreement with the responses from the first survey.

 

RESULTS

The first survey resulted in strong inter-rate reliability among all users, meaning strong aggrement was showcased in the classification of the complications. The second survey even showed improved results or agreeability, suggesting the users had become more familiar and comfortable with the classification system.

Discussion Points

  • One limitation to the survey was it did not include severity scores for disease III and Device IV. They were not included because there were no complications that fit those severity grades from either institution.
  • Complications from magnetically controlled growth rods, spinal tethers or spinal staples were not included, however in the future these devices should be included in the reporting using the classification system

    • Using the Complication Classification System for Growth Friendly Surgery should be used for all reporting regarding growth friendly treatments. Adopting this system will allow for more robust and qualitative comparison of complications between treatment options