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- Title
Using Equipoise to Determine the Radiographic Characteristics Leading to Agreement on Best Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficits.
- Authors
Dandurand, Charlotte; Dvorak, Marcel F.; Hazenbiller, Olesja; Bransford, Richard J.; Schnake, Klaus J.; Vaccaro, Alexander R.; Benneker, Lorin M.; Vialle, Emiliano; Schroeder, Gregory D.; Rajasekaran, Shanmuganathan; El-Skarkawi, Mohammad; Kanna, Rishi M.; Aly, Mohamed M.; Holas, Martin; Canseco, Jose A.; Muijs, Sander; Popescu, Eugen C.; Tee, Jin Wee; Camino-Willhuber, Gaston; Joaquim, Andrei Fernandes
- Abstract
Study Design: Retrospective analysis of prospectively collected data. Objectives: Our goal was to assess radiographic characteristics associated with agreement and disagreement in treatment recommendation in thoracolumbar (TL) burst fractures. Methods: A panel of 22 AO Spine Knowledge Forum Trauma experts reviewed 183 cases and were asked to: (1) classify the fracture; (2) assess degree of certainty of PLC disruption; (3) assess degree of comminution; and (4) make a treatment recommendation. Equipoise threshold used was 77% (77:23 distribution of uncertainty or 17 vs 5 experts). Two groups were created: consensus vs equipoise. Results: Of the 183 cases reviewed, the experts reached full consensus in only 8 cases (4.4%). Eighty-one cases (44.3%) were included in the agreement group and 102 cases (55.7%) in the equipoise group. A3/A4 fractures were more common in the equipoise group (92.0% vs 83.7%, P <.001). The agreement group had higher degree of certainty of PLC disruption [35.8% (SD 34.2) vs 27.6 (SD 27.3), P <.001] and more common use of the M1 modifier (44.3% vs 38.3%, P <.001). Overall, the degree of comminution was slightly higher in the equipoise group [47.8 (SD 20.5) vs 45.7 (SD 23.4), P <.001]. Conclusions: The agreement group had a higher degree of certainty of PLC injury and more common use of M1 modifier (more type B fractures). The equipoise group had more A3/A4 type fractures. Future studies are required to identify the role of comminution in decision making as degree of comminution was slightly higher in the equipoise group.
- Subjects
SIZE reduction of materials; DECISION making; EXPERIMENTAL design
- Publication
Global Spine Journal, 2024, Vol 14, p25S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/21925682231215770