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PubMed1994

Interobserver agreement in the classification of open fractures of the tibia. The results of a survey of two hundred and forty-five orthopaedic surgeons.

The system of Gustilo and Anderson for the classification of open fractures is commonly used as a basis for treatment decisions and for comparison of the published results of treatment. The reliability of this classification system was tested on the basis of the responses of 245 orthopaedic surgeons to a survey. The respondents were asked to provide data about their age, type of practice, and type of training; the number of open fractures of the tibia that they treated each year; and their use of the Gustilo-Anderson classification system. They were also asked to classify twelve open fractures of the tibia on the basis of a series of videotaped case presentations. Each case presentation on the color videotape included demographic data on the patient, a history of the injury, the results of the physical examination, the appearance and dimensions of the open wound before the operation, preoperative radiographs, and selected portions of the operative débridement with narration. The level of agreement for the classification of each fracture was determined according to the largest percentage of observers who chose a single classification type. The average agreement among the observers for all twelve fractures was 60 percent. The over-all agreement for each fracture ranged from 42 to 94 percent. The average agreement in the subgroup of surgeons who were considered to have the least experience (residents and fellows) was 59 per cent (range, 33 to 94 percent).(ABSTRACT TRUNCATED AT 250 WORDS)

Fractures, Open↗
PubMed1999

Stulberg classification system for evaluation of Legg-Calvé-Perthes disease: intra-rater and inter-rater reliability.

BACKGROUND: Researchers and clinicians commonly use the classification system of Stulberg et al. as a basis for treatment decisions during the active phase of Legg-Calvé-Perthes disease because of its putative utility as a predictor of long-term outcome. It is generally assumed that this system has an acceptable degree of reliability. This assumption, however, is not convincingly supported by the literature. METHODS: The purpose of the present study was to assess the inter-rater and intra-rater reliability of the classification system of Stulberg et al. with use of a pre-test, post-test design. During the pre-test phase, nine raters independently used the system to evaluate the radiographs of skeletally mature patients who had been managed for Legg-Calvé-Perthes disease. The intervention between the pre-test and post-test phases consisted of a consensus-building session during which all raters jointly arrived at standardized definitions of the various joint structures that are assessed with use of the classification system. The effect of these definitions on reliability then was assessed by reevaluating the radiographs during the post-test phase. RESULTS: The pre-test intra-rater reliability coefficients ranged from 0.709 to 0.915, and the post-test coefficients ranged from 0.568 to 0.874. The pre-test inter-rater reliability coefficients ranged from 0.603 to 0.732, and the post-test coefficients ranged from 0.648 to 0.744. Contributing to the variance was a lack of agreement concerning the assessment of joint structures and the way in which the raters translated these evaluations into a classification according to the system of Stulberg et al. CONCLUSIONS: Although intra-rater reliability was marginally acceptable, the degree of variability between the classifications assigned by different raters even after the intervention - calls into question the reliability of the system of Stulberg et al.; consequently, the validity of any treatment decisions, outcome evaluations, or epidemiological studies based on this system is also in question.

Acetabulum↗
PubMed1982

Selection of vasodilator drugs for patients with severe chronic heart failure: an approach based on a new classification.

Although vasodilator drugs are of proven worth in the management of patients with severe heart failure, a useful system of classification of vasodilator drugs has not yet been devised. The traditional system of classification based on the dominant arterial and/or venous sites of action as determined by limb plethysmography has major conceptual and practical limitations. This article discusses the merits of a new classification format based on pharmacological mechanisms of action. According to this new system, vasodilator drugs can be divided into two groups: (1) direct-acting agonists (hydralazine, minoxidil, nitrates and nitroprusside) which demonstrate dose-dependent responses and generalised vasodilator effects, and thus require invasive monitoring for dose titration; and (2) neurohumoral antagonists (prazosin, trimazosin, phentolamine, captopril and teprotide), whose effects are qualitatively and quantitatively independent of the dose administered, show marked regional heterogeneity and have characteristic temporal patterns of response. This new classification system permits the rational formulation of clinical recommendations concerning the choice of a vasodilator drug for patients with severe chronic heart failure. However, widespread application of this new classification system awaits the development of reliable means of identifying patients with neurohumoral-dependent vasoconstriction without the necessity of a therapeutic trial.

Heart Failure↗
PubMed1998

The classification of mental disorders in primary care: a guide through a difficult terrain.

BACKGROUND: Primary care physicians traditionally have a strong interest in the mental health of their patients. Three classification systems are available for them to diagnose, label, and classify mental disorders: 1) The ICD-10 approach with three options, 2) The DSM-IV approach with two options, and 3) the ICPC approach with two options. This article lists important similarities and differences between the systems to help potential users choose the option that best meets their needs. METHODS: Definitions for depressive disorder, anxiety disorder, and somatization disorder are compared on five characteristics of classification: 1. the domain, 2. the scope, 3. the nature of the definitions, 4. focus on episodes of care, and 5. clinical guidelines. RESULTS: Primary care physicians and psychiatrists have different perspectives, reflected in different classifications. Each system has specific possibilities and limitations with regard to the diagnosis of mental disorders. For common mental disorders it is possible, however, to choose codes from one system while maintaining compatibility with the other two. Comparability as to the diagnostic content of the different classes, however, is more difficult to establish. The available classification systems give both primary care physicians and psychiatrists options to diagnose, label, and to classify mental disorders from their own perspective, but once a system has been chosen the clinical comparability of a patient with the same diagnosis in other systems is limited. CONCLUSION: Compatibility among systems can be optimized by strictly following a number of rules. The conversion between ICPC and ICD-10 (and consequently DSM-IV) allows simultaneous use of ICPC and ICD-10 as a classification and DSM-IV as the standard nomenclature. This is of particular interest for computer based patient records in primary care. The clinical comparability of the same diagnosis in different systems however is limited by the characteristics of the different system.

Anxiety Disorders↗
PubMed2004

PLS dimension reduction for classification with microarray data.

Partial Least Squares (PLS) dimension reduction is known to give good prediction accuracy in the context of classification with high-dimensional microarray data. In this paper, the classification procedure consisting of PLS dimension reduction and linear discriminant analysis on the new components is compared with some of the best state-of-the-art classification methods. Moreover, a boosting algorithm is applied to this classification method. In addition, a simple procedure to choose the number of PLS components is suggested. The connection between PLS dimension reduction and gene selection is examined and a property of the first PLS component for binary classification is proved. In addition, we show how PLS can be used for data visualization using real data. The whole study is based on 9 real microarray cancer data sets.

Journal Article↗
PubMed2006

Variability in mesothelioma tumor response classification.

OBJECTIVE: The objective of our study was to evaluate observer variability in the measurement of temporal change in mesothelioma tumor thickness and in the resulting tumor response classification from CT scans. In addition, the performance of a semiautomated measurement method was evaluated. MATERIALS AND METHODS: Four observers individually used an interface that displayed two serial CT scans from the same patient to measure mesothelioma tumor thickness on the follow-up CT scans of 22 patients based on baseline scan measurements. During one session, observers acquired measurements on the follow-up scans based on written reports of baseline scan measurements; in another session, baseline scan measurements were superimposed on the baseline scan for direct visual comparison. Follow-up scan measurements also were obtained from a semiautomated method. Measurement variability and tumor response classification concordance were evaluated for manual measurements acquired in both modes and for semiautomated measurements. RESULTS: Although only a small increase in tumor response classification concordance rate was obtained with the visual approach (84.8%) relative to the more standard written-report approach (82.6%), the actual measurements acquired by observers were statistically significantly different between the two approaches (p = 0.03). Both the semiautomated measurements and the resulting tumor response classifications were consistent with manual measurements. CONCLUSION: The presentation of baseline scan tumor measurements affects measurements acquired on follow-up scans and could influence tumor response classification. The potential utility of semiautomated tumor thickness measurements was shown in the context of measuring tumor response.

Adult↗
PubMed1998

Clinical classification of patellofemoral pain and dysfunction.

The patellofemoral joint is a complex articulation based on its dependence on both dynamic and static restraints for stability. Classification of patellofemoral disorders has been frought with confusion. However, progress has been made in the classification and understanding of these disorders by improved understanding of the biomechanics of the joint and by clarification of the terminology to describe patellofemoral pathology. The term chondromalacia patella, although once used as an all-inclusive term for anterior knee pain, is now widely accepted as a term used to describe pathologic lesions of the patellar articular cartilage found at arthroscopy or arthrotomy. An adequate classification system should aid in proper diagnosis and treatment of specific problems. If properly devised, it should also aid in the comparison of results between different treatment centers. In addition, it should be a system that is simple and useful in the clinical setting with minimal use of complicated imaging techniques. From a clinical perspective, patellofemoral problems in the skeletally mature patient fall into three broad categories: 1) patellofemoral instability, i.e., subluxation or dislocation; 2) patellofemoral pain with malalignment but no episodes of instability; and 3) patellofemoral pain without malalignment. The myriad of patellofemoral disorders then fall into subclassifications of these categories. Treatment algorithms can be broadly developed based on the general category, with specific treatments based on the subclassification. In this paper, the authors will present a review of the pertinent literature documenting patellofemoral classification systems and develop concepts of clinical classification of patellofemoral disorders based on the three categories described above.

Adolescent↗
PubMed1999

Reliability of McConnell's classification of patellar orientation in symptomatic and asymptomatic subjects.

STUDY DESIGN: Test-retest reliability study with blinded testers. OBJECTIVES: To determine the intratester reliability of the McConnell classification system and to determine whether the intertester reliability of this system would be improved by one-on-one training of the testers, increasing the variability and numbers of subjects, blinding the testers to the absence or presence of patellofemoral pain syndrome, and adhering to the McConnell classification system as it is taught in the "McConnell Patellofemoral Treatment Plan" continuing education course. BACKGROUND: The McConnell classification system is currently used by physical therapy clinicians to quantify static patellar orientation. The measurements generated from this system purportedly guide the therapist in the application of patellofemoral tape and in assessment of the efficacy of treatment interventions on changing patellar orientation. METHODS AND MEASURES: Fifty-six subjects (age range, 21-65 years) provided a total of 101 knees for assessment. Seventy-six knees did not produce symptoms. A researcher who did not participate in the measuring process determined that 17 subjects had patellofemoral pain syndrome in 25 knees. Two testers concurrently measured static patellar orientation (anterior/posterior and medial/lateral tilt, medial/lateral glide, and patellar rotation) on subjects, using the McConnell classification system. Repeat measures were performed 3-7 days later. A kappa (kappa) statistic was used to assess the degree of agreement within each tester and between testers. RESULTS: The kappa coefficients for intratester reliability varied from -0.06 to 0.35. Intertester reliability ranged from -0.03 to 0.19. CONCLUSION: The McConnell classification system, in its current form, does not appear to be very reliable. Intratester reliability ranged from poor to fair, and intertester reliability was poor to slight. This system should not be used as a measurement tool or as a basis for treatment decisions.

Adult↗
PubMed2004

Diagnostic classification and orthopaedic physical therapy practice: what we can learn from medicine.

Concepts of diagnosis and classification have a long history in medicine, while formal schemes of diagnostic classification in physical therapy are relatively new. Basic differences exist between medicine and physical therapy in the phenomena which are diagnosed and classified. However, similarities in the diagnostic and classification process provide an opportunity to learn from medicine as the process now evolves in physical therapy. This paper provides a brief history of the development of the concept of diagnostic classification in medicine and physical therapy. Difficulties associated with the process are described. Knowledge of these difficulties is used to analyze some of the evolving concepts of diagnostic classification in physical therapy, especially those related to orthopaedic physical therapy practice.

Clinical Competence↗
PubMed1992

Sensory, physical, and chemical properties of pork loin chops from somatotropin-treated pigs of three stress classifications.

Forty-eight pigs of three known stress classifications were injected daily with porcine somatotropin (pST; 4 mg/d) or placebo. The effects of pST and stress classification on the sensory, physical and chemical characteristics of loin chops were observed. Chops from pST-treated animals were less tender and juicy than chops from control animals. Positive stress classification also significantly decreased juiciness but had no effect on tenderness and flavor. A significant interaction was observed for initial juiciness and sustained juiciness between chops from pST and stress-positive pigs. Whereas chops from carriers and normal pigs showed a reduction in juiciness traits with the pST treatment, among stress-positive animals both initial and sustained juiciness were increased with pST treatment. Treatment with pST had no effect on the fat, protein, and moisture content of the longissimus muscle. Furthermore, stress classification had no effect on the fat and moisture content of the longissimus muscle, but protein content was significantly higher in loin chops from stress-positive animals. Chops from pST-treated animals had significantly higher maximum shear force values, required more energy to break the sample, and had higher yield point values than chops from control animals, but stress classification did not affect the shear force values significantly. Treatment of stress-susceptible animals with pST does not lead to an increased incidence of pale, soft, exudative meat and may improve juiciness attributes of chops from stress-positive animals. However, pST treatment of animals, in this trial, led to a reduction of juiciness and tenderness of pork loin chops.

Animals↗
PubMed1992

Suitability of slit lamp retroillumination photographs for classifying cataracts according to 'Lens Opacities Classification System II (LOCS II)'.

The Lens Opacities Classification System II (LOCS II) utilizes photographic standards (two retroilluminated Neitz-CTR and one standard slit lamp Zeiss photographs) for the classification of cortical and posterior subcapsular cataracts, nuclear color and nuclear opalescence. However, dedicated photographic devices, particularly retroillumination cameras, are not always available and this study was aimed at evaluating the suitability of a retroillumination photographic technique with a standard slit lamp camera for cortical and posterior subcapsular cataract classification according to LOCS II. Two observers examined 273 eyes. Kappa statistics demonstrated that agreement between the standard slit lamp, clinical grading (according to published LOCS II methodology) and photographic grading (according to our photographic technique), as well as inter- and intraobserver reproducibility, were excellent (Kappa > 0.74) for the classification of all lenticular regions. The results indicate that a standard slit lamp camera can be as useful as a dedicated retroillumination camera when LOCS II standards are used for cataract classification.

Adult↗
PubMed1990

Cancer of the supraglottic larynx with neck node metastasis treated by radiation therapy only. The revised 1987 UICC classification system as prognostic indicator.

In 1987, a thoroughly renewed TNM classification was published; the revision was a conjunct effort of the International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC). With respect to the former UICC classification, a major change was introduced regarding the regional lymph node subcategories in head and neck cancer; that is compared to the 1978 edition the subjective subcategory of fixation was eliminated and size of the lymph node has become of paramount importance. To see whether the 1987 UICC classification system is indeed more predictive and discriminatory than the 1978 edition, we have analysed patients with supraglottic cancer with clinically detectable lymph node metastasis (T1-4, N+). All patients treated between 1965 and 1980 by radiation therapy only were staged according to both editions of the UICC classification system. From these data we conclude that the prognosis of patients with lymph nodal involvement indeed worsens from N1 to N3 when classified according to the 1987 edition; in contrast, no difference is seen between the N1, N2 or N3 subcategories when staged according to the 1978 classification rules.

Carcinoma, Squamous Cell↗
PubMed1987

Criteria for the classification of osteoarthritis of the knee and hip.

The Osteoarthritis (OA) Criteria Subcommittee of the American Rheumatism Association set out to develop (a) a classification of OA that includes recognised subsets; and (b) subsets of OA identified by a combination of clinical and laboratory features. For the purposes of classification, OA should be specified if of unknown origin (idiopathic, primary) or if related to a known medical condition or event (secondary). Clinical criteria for classification of idiopathic OA of the knee were developed through a multicentre study group involving 130 patients with OA and 107 comparison patients. Comparison diagnoses included rheumatoid arthritis (RA) and other painful conditions of the knee exclusive of referred or para-articular pain. Variables from the history, physical examination, laboratory test results and radiographs were used to develop sets of criteria that serve different investigative purposes: clinical examination (sensitivity 89%; specificity 88%); clinical examination and laboratory tests (sensitivity 88%; specificity 93%); clinical examination, laboratory tests and radiographs (sensitivity 94%; specificity 88%). In contrast to prior classification criteria, the proposed criteria utilise decision trees or algorithms. Clinical criteria for classification of idiopathic OA of the hip are under development. Comparison groups are comprised of patients with other rheumatic diseases (e.g. RA), periarticular pain (e.g. trochanteric bursitis) and referred pain (e.g low back pain). From a method of opinion sampling, OA of the hip may be suggested by a combination of clinical criteria including the following: age greater than 40 years, weight-bearing pain, pain relieved by sitting, antalgic gait, decreased painful range of motion, a normal erythrocyte sedimentation rate (ESR) and a negative rheumatoid factor test.

Algorithms↗
PubMed1993

The accuracy of the histological classification of lung carcinoma and its reproducibility: a study of 75 archival cases of adenosquamous carcinoma.

The classification of lung carcinoma into a small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC), is highly reproducible. There are few studies on the reproducibility of subtyping NSCLC, with anecdotal reports on the subtype of adenosquamous carcinoma. We undertook a study of 75 cases archived as adenosquamous carcinoma. All cases were accepted as NSCLC on independent review by three pathologists utilizing the 1982 World Health Organization (WHO) classification criteria. The acceptance rate of adenosquamous carcinoma by the three pathologists was 65%, 28%, and 65%. Cases not accepted as adenosquamous fell into the different subtypes of NSCLC, with a concordance rate between each pair of pathologists of 49%, 61% and 43%, indicating poor agreement between pathologists. The study confirms the high reproducibility of the classification into SCLC and NSCLC; it shows poor concordance for all subtypes of NSCLC with poor reproducibility of diagnosis of adenosquamous carcinoma as specified by the 1982 WHO classification. Physicians dealing with lung carcinoma should be aware of this limitation of classification.

Carcinoma, Adenosquamous↗
PubMed1999

Clinicopathological evaluation of the Revised European-American Classification of Lymphoid Neoplasms (REAL) in Japan.

After the publication of a Revised European-American Classification of Lymphoid Neoplasms (REAL classification) in 1994, there have been reports from Europe and America regarding its practical utility and clinical significance. However, no studies have been published from Eastern countries including Japan. It has been well recognized that the distribution of malignant lymphoma in Japan is quite different from that seen in Western countries. In addition, some new entities have also been described in the REAL classification. Therefore, it seems important to examine its practical utility and clinical significance in Japan. Of the 579 cases reviewed, approximately 68% were B-cell non-Hodgkin's lymphoma (NHL) followed by 27% T-cell lymphomas. Hodgkin's disease (HD) comprised only 5% of all cases, making the ratio of NHL to HD 20.6. The most common type was diffuse large B-cell lymphoma which represented about 37% of all cases. Peripheral T-cell lymphomas, unspecified (PTCL), occurred in 15% whereas marginal zone B-cell lymphoma followed (14.9%). However, follicle center lymphoma (FCL) was less common (4.4%) as has been previously reported. We evaluated the clinical significance of the new REAL classification in 244 cases. International Prognostic Index (IPI) was a powerful predictor of survival (p<0.0001), and the immunophenotype was significant (p<0.05). Furthermore, here, we also attempt to establish a prognostic scheme based on the histologic type. In conclusion, the REAL classification appears to be useful and clinically significant in Japan.

Adolescent↗
PubMed1975

Classification of medial fractures of the femoral neck.

In this study 444 consecutive cases of medial fracture of the femoral neck treated in the city of Turku are considered on the basis of the proposals of Garden (1961) and Pauwels (Leitz 1966) for the classification of fracture types. In order to find out what kind of classification is most practical and coherent a retrospective comparison of the progress of healing was made on the basis of the aforementioned classifications of fracture. Garden's classification proved to be far more logical and was much more reliable for the prognosis of recovery. For this reason and also because of the ease with which his criteria can be applied, the present authors recommend the general use of Garden's classification.

Femoral Neck Fractures↗
PubMed2004

Developing a classification tool based on Bloom's taxonomy to assess the cognitive level of short essay questions.

The cognitive level of short essay questions taken from assessments of two veterinary courses at the Faculty of Veterinary Medicine of Utrecht University (FVMU) was evaluated using a simplified classification tool based on the taxonomy of Bloom. Classifications were made by teaching staff members (subject matter experts, or SME) and by faculty members not involved in teaching the course (non-subject matter experts, or NSME). To compare the cognitive level assigned by raters in the SME group to that assigned by the NSME group, each test item was assigned a modal taxonomic level. The results indicate that the agreement level between a pair of raters within a group (SME or NSME) differed (34% to 77% and linear weighted Cohen's kappa coefficient 0.12 to 0.60). The agreement level on the modal taxonomic level between the SME and NSME groups for the two courses was 65% and 73%, with a linear weighted Cohen's kappa coefficient of 0.43 and 0.63 respectively. The requirement of expertise of a subject for classification is discussed. The introduction of the classification tool had a positive effect on teaching staff members' awareness of the importance of the cognitive level of assessments. Improvements to the classification tool to obtain higher agreement levels are proposed.

Curriculum↗
PubMed2001

Patterns of functional magnetic resonance imaging activation in association with structural lesions in the rolandic region: a classification system.

OBJECT: Functional magnetic resonance (fMR) imaging of the motor cortex is a potentially powerful tool in the preoperative planning of surgical procedures in and around the rolandic region. Little is known about the patterns of fMR imaging activation associated with various pathological lesions in that region or their relation to motor skills before surgical intervention. METHODS: Twenty-two control volunteers and 44 patients whose pathologies included arteriovenous malformations (AVMs; 16 patients), congenital cortical abnormalities (11 patients), and tumors (17 patients) were studied using fMR imaging and a hand motor task paradigm. Activation maps were constructed for each participant, and changes in position or amplitude of the motor activation on the lesion side were compared with the activation pattern obtained in the contralateral hemisphere. A classification scheme of plasticity (Grades 1-6) based on interhemispheric pixel asymmetry and displacement of activation was used to compare maps between patients, and relative to hand motor dexterity and/or weakness. There was 89.4% interobserver agreement on classification of patterns of fMR imaging activation. Displacement of activation by mass effect was more likely with tumors. Cortical malformations offer a much higher functional reorganization than AVMs or tumors. High-grade plasticity is recruited to compensate for severe motor impairment. CONCLUSIONS: Pattern modification of fMR imaging activation can be systematized in a classification of motor cortex plasticity. This classification has shown good correlation among grading, brain lesions, and motor skills. This proposal of a classification scheme, in addition to facilitating data collection and processing from different institutions, is well suited for comparing risks associated with surgical intervention and patterns of functional recovery in relation to preoperative fMR imaging categorization. Such studies are underway at the authors' institution.

Adolescent↗