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Study compares reliability, agreement of Della Valle vs Brooker classification systems
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Although researchers of this study found moderate interobserver agreement with both the Brooker and Della Valle classification systems for heterotopic ossification, they noted more reliability among observers when determining Della Valle grade C.
“Neither system was found to be superior, and both systems had only moderate interobserver agreement. However, the Della Valle classification system had more consistent intraobserver reliability among the 3 observers,” the researchers wrote.
Three clinicians reviewed 236 patients with documented radiographic heterotopic ossification at least 2 months after total hip arthroplasty. Using the Brooker scale and the Della Valle classification system, the reviewers noted the grade of heterotopic ossification on anteroposterior pelvic radiographs. For each classification system, Kenton R. Kaufman, PhD, PE, and colleagues assessed intraobserver reliability and interobserver agreement with Cohen’s kappa coefficient of agreement.
Results showed moderate to substantial intraobserver reliability with the Brooker scale and substantial intraobserver reliability with the Della Valle classification system. Researchers noted moderate interobserver agreement among both classification systems, with the best interobserver agreement in Della Valle grade C and Brooker grade IV. Grade C of the Della Valle classification system showed substantial interobserver reliability and was the best interobserver agreement for any grade, according to results.
“The Della Valle classification system may be slightly better in patients with large amounts of heterotopic ossification, but both classification systems lack sufficient clarity and are open to significant subjective interpretation,” the researchers wrote. – by Casey Tingle
Disclosures: Kaufman and Vasileiadis report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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