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Journal of Bone and Joint Surgery - British Volume, Vol 84-B, Issue 7, 950-954.
doi: 10.1302/0301-620X.84B7.13010  
Copyright © 2002 by British Editorial Society of Bone and Joint Surgery
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Improved interobserver variation after training of doctors in the Neer system

A RANDOMISED TRIAL

S. Brorson, MD, Research Fellow1; J. Bagger, MD, Consultant Orthopaedic Surgeon2; A. Sylvest, MD, Consultant Orthopaedic Surgeon2; and A. Høbjartsson, MD, Research Fellow1

1 Department of Medical Philosophy and Clinical Theory, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200 Copenhagen NV, Denmark.
2 Department of Orthopaedic Surgery, Bispebjerg University Hospital, DK-2400 Copenhagen NV, Denmark.

Correspondence should be sent to Dr S. Brorson.

We investigated whether training doctors to classify proximal fractures of the humerus according to the Neer system could improve interobserver agreement. Fourteen doctors were randomised to two training sessions, or to no training, and asked to categorise 42 unselected pairs of plain radiographs of fractures of the proximal humerus according to the Neer system. The mean kappa difference between the training and control groups was 0.30 (95% CI 0.10 to 0.50, p = 0.006). In the training group the mean kappa value for interobserver variation improved from 0.27 (95% CI 0.24 to 0.31) to 0.62 (95% CI 0.57 to 0.67). The improvement was particularly notable for specialists in whom kappa increased from 0.30 (95% CI 0.23 to 0.37) to 0.79 (95% CI 0.70 to 0.88). These results suggest that formal training in the Neer system is a prerequisite for its use in clinical practice and research.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General