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A simplified classification of proximal femoral fractures improves accuracy, confidence, and inter-reader agreement of hip fracture classification by radiology residents

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Abstract

Purpose

To demonstrate the effect of teaching a simplified treatment-based classification of proximal femoral fractures on the accuracy, confidence, and inter-reader agreement of radiology residents. The authors hypothesize that these measures will improve after viewing an educational presentation.

Materials and methods

Three radiology residents independently classified 100 operative proximal femoral fractures, both before and after viewing a 45-min educational video describing the simplified classification scheme, with a washout period of at least 12 weeks between sessions. Based on the gold standard established by consensus of two radiologists and an orthopedic trauma surgeon utilizing intraoperative fluoroscopic imaging, operative reports, and pre-procedural imaging, accuracy of classification was calculated for each reader before and after viewing the educational video. Reader confidence was recorded on a 0–10 scale, and inter-reader agreement was calculated with Fleiss’s kappa. McNemar’s test was used to compare accuracy, a paired t test was used to compare confidence, and the Z-test was used to compare kappa values after bootstrapping to determine the standard error of the mean.

Results

The study cohort included 60/100 females, with a mean age of 76.6 years. The pooled classification accuracy was initially 65%, which improved to 80% in the second reading session after viewing the educational video (p < 0.0001). Confidence improved from 6.9 initially to 8.6 (p < 0.0001). Inter-reader agreement improved from a kappa of 0.45 (moderate agreement) to 0.74 (substantial agreement) (p < 0.0001).

Conclusions

A simplified treatment-based classification of proximal femoral fractures is easily taught to radiology residents and resulted in increased accuracy, increased inter-reader agreement, and increased reader confidence.

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Authors and Affiliations

  1. Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Jacob C. Mandell, William C. Wrobel, Olga Laur, Nandish Shah, Cory Robinson-Weiss & Bharti Khurana

  2. Division of Musculoskeletal Imaging and Intervention, Brigham and Women’s Hospital, Boston, MA, USA

    Jacob C. Mandell & William C. Wrobel

  3. Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Michael J. Weaver

  4. Division of Emergency Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Bharti Khurana

Authors
  1. Jacob C. Mandell
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  2. William C. Wrobel
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  3. Olga Laur
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  4. Nandish Shah
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  5. Cory Robinson-Weiss
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  6. Michael J. Weaver
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  7. Bharti Khurana
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Corresponding author

Correspondence to Jacob C. Mandell.

Ethics declarations

This retrospective study was approved by our institutional review board with waiver of informed consent and was in compliance with Health Insurance Portability and Accountability Act regulations.

Conflict of interest

The authors declare that they have no conflict of interest.

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Mandell, J.C., Wrobel, W.C., Laur, O. et al. A simplified classification of proximal femoral fractures improves accuracy, confidence, and inter-reader agreement of hip fracture classification by radiology residents. Emerg Radiol 26, 179–187 (2019). https://doi.org/10.1007/s10140-018-1660-5

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  • DOI: https://doi.org/10.1007/s10140-018-1660-5

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