PubMed · 404467
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V J DiStefano. 1977. Athletic injuries.. https://doi.org/10.1111/j.1746-1561.1977.tb01048.x
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Studies using kappa statistics have been conducted with a varied but limited number of observers. The aim of this study was to evaluate the significance of multiple observers on kappa as a measure of observer variation. One hundred orthopedic specialists were asked to assess a random sample of ten sets of standard radiographs of 94 consecutive patients with ankle fractures. The observers were randomly allocated into four groups, which again were divided into subgroups with an increasing number of observers. Random subgroups of three observers revealed kappa values from 0.20 to 0.64 in the Lauge-Hansen and 0.27 to 0.90 in the Weber classification system. With an increasing number of observers in the subgroups, kappa stabilizes around a mean value, indicating that the sampling variation and standard error decrease. The standard error found in this study makes kappa questionable as a measure for agreement among a small number of observers. Thus, kappa values obtained for a given diagnostic tool at one department are not directly comparable with results from other departments. We conclude that kappa cannot stand alone as a simple measure of observer variation.
The Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study examines the risk factors for fractures and low bone density in middle-aged women. In the present study we investigated lifestyle and other risk factors for ankle fracture. The study population consisted of 11,798 women, aged 47-56 years at baseline. During the 5 year follow-up, these women sustained 194 validated malleolar fractures, giving an incidence of 3.4 fractures/1000 person-years. Four independent predictors for malleolar fracture were detected: smoking; multipharmacy; fracture history; and overweight status. The hazard ratio (HR) for positive fracture history was 1.63 (p = 0.005). In women with a body mass index (BMI) of 25-30 kg/m(2) vs. those with a BMI <25 kg/m(2), HR was 1.69 (p = 0.003). Those who used three or more prescribed drugs had an HR of 2.03 (p = 0.0003) vs. those who used no drugs. Smoking had a dose-response effect, with HRs of 1.73 (p = 0.016) in those smoking 1-19 cigarettes/day, and 2.94 (p = 0.001) in those smoking > or =20 cigarettes/day. Lifestyle factors and fracture history appear to be important predictors of ankle fracture.
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