E-Book, Englisch, 540 Seiten, ePub
Reihe: AO-Publishing
Dettori / Chapman / Norvell Spine Classifications and Severity Measures
1. Auflage 2009
ISBN: 978-3-13-258192-0
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark
E-Book, Englisch, 540 Seiten, ePub
Reihe: AO-Publishing
ISBN: 978-3-13-258192-0
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Care of spinal conditions has become increasingly complex and confusing. Classification systems can help in understanding the subject matter at hand, but have exploded in numbers and complexity. Attempts at extracting classifications of spinal disorders are cumbersome and require careful study of numerous reference books without achieving a comprehensive overview in the end. This one of a kind reference text summarizes over 185 spine classification or severity easures with standardized art work, provides ratings and critical evaluations of pertinent strengths and weaknesses in a concise and systematic fashion and provides help in:
Studying spinal disease conditions
Preparing informed treatment decisions
Communicating individual patient disease severity
Evaluating publications regarding treatment results and success
Formulating spinal research projects
Providing a scientific reference tool
The book is divided into two major systems
Disease severity:
General disease severity
Instability
Osteoporosis
Stenosis
Spinal deformity
Degenerative disorders
Infection
Tumor
Heterotopic ossification
Trauma severity:
General trauma scores
Spinal cord injury
Fracture classifications
All identified measures within each category are formally reviewed and displayed in a unique visually friendly manner containing:
A one of a kind compendium of high quality diagrams for each severity measure or classification system with unrivaled specificity and detail
The content of each measure and whether it incorporates the critically important ABCDs of disease severity including: an anatomical component, a biomechanical component, a clinical component, and the degree of severity component
A summary of the measures validity, reliability, and predictive ability with corresponding patient populations
An evaluation of each measure using our scoring criteria focusing on methodological rigor and clinical utility
An overall score for each measure rating the instrument’s strength with respect to methodology and clinical utility
Zielgruppe
Ärzte
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
1 Spine classification systems to spine disease severity measures: a paradigm shift
2 Method for identifying and evaluating spine severity measures
3 What makes a quality severity measure?
4 How the severity measures are displayed in this book
5 Spine disease severity measures
6 Spine trauma severity measures
7 Going beyond classification systems: new horizons for adolescent idiopathic scoliosis
2 Method for identifying and evaluating spine severity measures
1 Explanation of search strategy
2 Summary of severity measure content
3 Summary of severity measure methodological evaluation
4 Summary of severity measure clinical utility evaluation
5 Summary of the severity measure score
6 Justification for our scoring method
7 How to use the overall score
2 Method for identifying and evaluating spine severity measures
1 Explanation of search strategy
Our intent was to identify spine-specific disease and trauma severity measures reported in the literature. We intended to identify the most commonly used measures. Therefore, if a measure had a history of consistent use it was included. The disease severity measures include these spine-specific domains: instability deformity degenerative disease, osteoporosis, infection, tumor, stenosis, and heterotopic ossification. The trauma severity measures include spinal cord injury spine fracture or injury classification, instability, and stenosis. The fracture and injury classification measures include fracture or injury to the occipital area, atlanto-occipital area, atlas, axis, subaxial cervical spine, whole cervical spine, thoracolumbar spine, lumbosacral spine, and whole spine. Both disease and trauma severity include a general domain.
We employed a systematic approach in identifying the spine severity measures. We began our process with a group of spine surgeons who created a list of the most common severity measures they use or encounter in the literature. We then proceeded to search all of MEDLINE® with a relatively generic search code to identify as many possible references in the literature that may contain a spine severity measure. We placed no limits on the date of publication because some severity measures developed several decades ago are the most commonly used spine severity measures today (eg, Nurick Scale for Cervical Myelopathy Severity and the Classification of Occipital Condyle Fractures by Anderson and Montesano). From a large list of initial references, additional severity measures were identified by reviewing the text and bibliographies of full-text articles. Additional severity measures were identified by using generic internet search engines (ie, Google™). A list of severity measures per domain was compiled and built upon throughout the search process. From this list, we first sought to locate the original article, then all studies in the literature that evaluated the severity measure's predictive validity and reliability (intra- and interobserver). For some, such evaluations were not reported in the literature. For others, there may have been one to several studies reported. Each severity measure was reviewed, summarized, and scored with respect to four major categories:
• content
• methodology
• clinical utility
• overall score
Finally each severity measure received an overall score on a scale from 0 to 10 by summing the scores from each major category.
2 Summary of severity measure content
Purpose
The purpose of the severity measure's content is to give the user a quick reference for understanding what the measure is attempting to assess and how the author(s) recommends it be quantified and interpreted. The content section provides a quick appraisal of the measure's success at including pertinent anatomy biomechanics, and clinical status (face/content validity), as well as whether it distinguishes between various degrees of severity. Content validity is defined and discussed in Chapter 3.
Method
We divided each measure into five major content areas:
| Name | We use the most common name found in the literature for each measure. In cases where a measure was referred to frequently by more than one name, both are included. |
| References | The bibliography includes the original article and subsequent articles that evaluated the measure's validity and reliability. |
| Type | We distinguish whether the measure is a disease severity or a trauma severity measure. |
| Scale | We assess whether the measure contains important diagnostic items relevant to evaluating spine disease severity (Anatomical, Biomechanical, Clinical, and Degree of severity items). |
| Interpretation | Interpretation informs the reader as to what the severity score or classification means. For example, are higher scores indicative of greater or lesser severity? |
Scoring
Content of the severity measure was scored based on the inclusion of the important diagnostic items in the severity measure's scale. The measure is awarded half a point for each item that is included in the severity measure (anatomical, biomechanical, clinical, and degree of severity). As a result, each measure could earn from 0 to 2 points for content.
3 Summary of severity measure methodological evaluation
Purpose
The purpose of the spine severity measure's methodological evaluation is to give the user a quick reference to what populations the measures were evaluated in and how the measures performed when subject to formal evaluation in the literature.
Method
The concepts defined in Chapter 3 (“What makes a quality severity measure?”) were the subject of this evaluation. For some severity measures, there was no record of evaluation. For those that were subject to evaluation, studies reporting results were referenced. We report results based on the interpretation of the author(s) who evaluated the severity measure's predictive validity and reliability.
| Predictive validity | We reported the characteristics of the populations in which the severity measures were evaluated (sample size, condition or treatment, mean age, and gender distribution), the outcomes the severity measures were validated against, and whether the severity measures were found to be predictive of outcome or not. |
| Reliability | We reported the characteristics of the populations in which the severity measures were evaluated (sample size, condition or treatment, mean age, and gender distribution), and whether the severity measures were found to be reliable or not reliable. |
Scoring
Scoring for methodology is divided between validity and reliability. One point is awarded if the severity measure was developed by predicting outcome in the index population. A second point is given if the measure was further tested for prediction in a second or test population. Points are given if the measure was tested for intraobserver (one point) or interobserver (one point) reliability. As a result, each measure could earn from 0 to 4 points for methodology.
4 Summary of severity measure clinical utility evaluation
Purpose
While a spine severity measure may contain the appropriate content and demonstrate adequate methods, it may be unduly cumbersome and complex, having too many categories of severity to easily memorize. The purpose of the spine severity measure's clinical utility evaluation is to give the user a quick reference of the relative ability of the severity measure to simplify categories of severity in terms of the number and the description of categories, and to help the provider in determining the appropriate treatment.
Method
We searched the literature to determine if previously established criteria were available by which to judge severity measure simplicity. We found none. Accepting that fewer categories of severity are simpler than many categories, we asked a panel of four spine surgeons to tell us the number of categories by which they would deem the measure to be ‘simple/easy’. It was determined by the panel that a measure with three or less categories would be regarded as such. Additionally it was determined that a single phrase to describe the severity category was simpler and easier than a more lengthy description. Furthermore, for a measure to be wholly useful, it must improve clinical decision making by assisting surgeons in choosing an optimal treatment based upon the different severity categories (ie, direct treatment). In this regard, we looked to see if the severity measure in the index population suggested surgery or if there was a cut-point in the severity score that distinguished between stability and instability. Finally we looked to see if any of the surgical recommendations based on severity categories were validated in a second or test population, a population different from the index population used to initially determine categories for surgical treatment.
| Simple | We determined if a severity measure was simple and easy to use based on whether the measure had three or less categories and contained a single phrase to describe each category. |
| Directs treatment | We determined if a severity measure predicted outcome or suggested surgical treatment in an index population and if that prediction or suggestion was validated in a second or test population. |
Scoring
Scoring for clinical utility is divided between simplicity and whether the measure suggests surgical treatment. One point was awarded for each of the following conditions:
• The severity measure has three or less...
