TY - JOUR
T1 - Spine Instability Neoplastic Score
T2 - agreement across different medical and surgical specialties
AU - Spanish Back Pain Research Network Task Force for the Improvement of Inter-Disciplinary Management of Spinal Metastasis
AU - Arana, Estanislao
AU - Kovacs, Francisco M.
AU - Royuela, Ana
AU - Asenjo, Beatriz
AU - Pérez-Ramírez, Úrsula
AU - Zamora, Javier
AU - Abraira, Víctor
AU - Alcázar, Lucía
AU - Alonso, Ana
AU - Álvarez, Luis
AU - Álvarez, Marco Antonio
AU - Amengual, Guillermo
AU - Antuña, Aida
AU - Aparici, Fernando
AU - Bagó, Joan
AU - Barriga, Andrés
AU - Barrios, María
AU - Bas, Paloma
AU - Begara, José
AU - Bravo-Rodríguez, Francisco
AU - Cabrera, Alberto
AU - Casillas, Carlos
AU - Catalán, Gregorio
AU - Conde, Antonio José
AU - de las Peñas, Ramón
AU - Díaz, Laura
AU - Dualde, Diego
AU - Estremera, Ana
AU - Fenollosa, Joaquín
AU - Fernández, Carlos
AU - Fernández, Eva
AU - Fernández-Baillo, Nicomedes
AU - Ferrer, Pilar
AU - Fuster, Salvador
AU - Galarraga, María Isabel
AU - García-Villar, Cristina
AU - García-Ferrer, Luis
AU - García, María Isabel
AU - García-Duque, Sara
AU - Garde, Javier
AU - González, Andrés
AU - González-Díaz, Rafael
AU - Hernández-Fernández, Alberto
AU - Hernando, Ovidio
AU - Hernanz, Raúl
AU - Hervás, Asunción
AU - Holgado, Esther
AU - Juan, María José
AU - Lavernia, Javier
AU - Lazo, Antonio
N1 - Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Background Context Spinal instability is an acknowledged complication of spinal metastases; in spite of recent suggested criteria, it is not clearly defined in the literature. Purpose This study aimed to assess intra and interobserver agreement when using the Spine Instability Neoplastic Score (SINS) by all physicians involved in its management. Study Design Independent multicenter reliability study for the recently created SINS, undertaken with a panel of medical oncologists, neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists, was carried out. Patient Sample Ninety patients with biopsy-proven spinal metastases and magnetic resonance imaging, reviewed at the multidisciplinary tumor board of our institution, were included. Outcome Measures Intraclass correlation coefficient (ICC) was used for SINS score agreement. Fleiss kappa statistic was used to assess agreement on the location of the most affected vertebral level; agreement on the SINS category (“stable,” “potentially stable,” or “unstable”); and overall agreement with the classification established by tumor board. Methods Clinical data and imaging were provided to 83 specialists in 44 hospitals across 14 Spanish regions. No assessment criteria were pre-established. Each clinician assessed the SINS score twice, with a minimum 6-week interval. Clinicians were blinded to assessments made by other specialists and to their own previous assessment. Subgroup analyses were performed by clinicians' specialty, experience (≤7, 8–13, ≥14 years), and hospital category (four levels according to size and complexity). This study was supported by Kovacs Foundation. Results Intra and interobserver agreement on the location of the most affected levels was “almost perfect” (κ>0.94). Intra-observer agreement on the SINS score was “excellent” (ICC=0.77), whereas interobserver agreement was “moderate” (ICC=0.55). Intra-observer agreement in SINS category was “substantial” (k=0.61), whereas interobserver agreement was “moderate” (k=0.42). Overall agreement with the tumor board classification was “substantial” (κ=0.61). Results were similar across specialties, years of experience, and hospital category. Conclusions Agreement on the assessment of metastatic spine instability is moderate. The SINS can help improve communication among clinicians in oncology care.
AB - Background Context Spinal instability is an acknowledged complication of spinal metastases; in spite of recent suggested criteria, it is not clearly defined in the literature. Purpose This study aimed to assess intra and interobserver agreement when using the Spine Instability Neoplastic Score (SINS) by all physicians involved in its management. Study Design Independent multicenter reliability study for the recently created SINS, undertaken with a panel of medical oncologists, neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists, was carried out. Patient Sample Ninety patients with biopsy-proven spinal metastases and magnetic resonance imaging, reviewed at the multidisciplinary tumor board of our institution, were included. Outcome Measures Intraclass correlation coefficient (ICC) was used for SINS score agreement. Fleiss kappa statistic was used to assess agreement on the location of the most affected vertebral level; agreement on the SINS category (“stable,” “potentially stable,” or “unstable”); and overall agreement with the classification established by tumor board. Methods Clinical data and imaging were provided to 83 specialists in 44 hospitals across 14 Spanish regions. No assessment criteria were pre-established. Each clinician assessed the SINS score twice, with a minimum 6-week interval. Clinicians were blinded to assessments made by other specialists and to their own previous assessment. Subgroup analyses were performed by clinicians' specialty, experience (≤7, 8–13, ≥14 years), and hospital category (four levels according to size and complexity). This study was supported by Kovacs Foundation. Results Intra and interobserver agreement on the location of the most affected levels was “almost perfect” (κ>0.94). Intra-observer agreement on the SINS score was “excellent” (ICC=0.77), whereas interobserver agreement was “moderate” (ICC=0.55). Intra-observer agreement in SINS category was “substantial” (k=0.61), whereas interobserver agreement was “moderate” (k=0.42). Overall agreement with the tumor board classification was “substantial” (κ=0.61). Results were similar across specialties, years of experience, and hospital category. Conclusions Agreement on the assessment of metastatic spine instability is moderate. The SINS can help improve communication among clinicians in oncology care.
KW - Medical specialty
KW - Observer agreement
KW - Reliability analysis
KW - Spinal instability
KW - Spinal metastases
KW - Spine Instability Neoplastic Score
UR - http://www.scopus.com/inward/record.url?scp=84949432236&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2015.10.006
DO - 10.1016/j.spinee.2015.10.006
M3 - Article
C2 - 26471708
AN - SCOPUS:84949432236
SN - 1529-9430
VL - 16
SP - 591
EP - 599
JO - Spine Journal
JF - Spine Journal
IS - 5
ER -