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dc.contributor.authorHoeritzauer, I
dc.contributor.authorPaterson, M
dc.contributor.authorJamjoom, AAB
dc.contributor.authorSrikandarajah, N
dc.contributor.authorSoleiman, H
dc.contributor.authorPoon, MTC
dc.contributor.authorCopley, PC
dc.contributor.authorGraves, C
dc.contributor.authorMacKay, S
dc.contributor.authorDuong, C
dc.contributor.authorLeung, AHC
dc.contributor.authorEames, N
dc.contributor.authorStatham, PFX
dc.contributor.authorDarwish, S
dc.contributor.authorSell, PJ
dc.contributor.authorThorpe, P
dc.contributor.authorShekhar, H
dc.contributor.authorRoy, H
dc.contributor.authorWoodfield, J
dc.date.accessioned2024-02-02T20:43:20Z
dc.date.available2024-02-02T20:43:20Z
dc.date.issued2023-09-01
dc.identifier.issn2049-4394
dc.identifier.issn2049-4408
dc.identifier.urihttps://pearl.plymouth.ac.uk/handle/10026.1/22014
dc.description.abstract

<jats:sec><jats:title>Aims</jats:title><jats:p>Patients with cauda equina syndrome (CES) require emergency imaging and surgical decompression. The severity and type of symptoms may influence the timing of imaging and surgery, and help predict the patient’s prognosis. Categories of CES attempt to group patients for management and prognostication purposes. We aimed in this study to assess the inter-rater reliability of dividing patients with CES into categories to assess whether they can be reliably applied in clinical practice and in research.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A literature review was undertaken to identify published descriptions of categories of CES. A total of 100 real anonymized clinical vignettes of patients diagnosed with CES from the Understanding Cauda Equina Syndrome (UCES) study were reviewed by consultant spinal surgeons, neurosurgical registrars, and medical students. All were provided with published category definitions and asked to decide whether each patient had ‘suspected CES’; ‘early CES’; ‘incomplete CES’; or ‘CES with urinary retention’. Inter-rater agreement was assessed for all categories, for all raters, and for each group of raters using Fleiss’s kappa.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Each of the 100 participants were rated by four medical students, five neurosurgical registrars, and four consultant spinal surgeons. No groups achieved reasonable inter-rater agreement for any of the categories. CES with retention versus all other categories had the highest inter-rater agreement (kappa 0.34 (95% confidence interval 0.27 to 0.31); minimal agreement). There was no improvement in inter-rater agreement with clinical experience. Across all categories, registrars agreed with each other most often (kappa 0.41), followed by medical students (kappa 0.39). Consultant spinal surgeons had the lowest inter-rater agreement (kappa 0.17).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Inter-rater agreement for categorizing CES is low among clinicians who regularly manage these patients. CES categories should be used with caution in clinical practice and research studies, as groups may be heterogenous and not comparable.</jats:p><jats:p>Cite this article: <jats:italic>Bone Joint J</jats:italic> 2023;105-B(9):1007–1012.</jats:p></jats:sec>

dc.format.extent1007-1012
dc.format.mediumElectronic
dc.languageen
dc.publisherBritish Editorial Society of Bone & Joint Surgery
dc.subjectHumans
dc.subjectCauda Equina Syndrome
dc.subjectReproducibility of Results
dc.subjectDecompression, Surgical
dc.subjectSurgeons
dc.titleCauda equina syndrome
dc.typejournal-article
dc.typeReview
dc.typeJournal Article
plymouth.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/37652459
plymouth.issue9
plymouth.volume105-B
plymouth.publisher-urlhttp://dx.doi.org/10.1302/0301-620x.105b9.bjj-2022-1343.r1
plymouth.publication-statusPublished
plymouth.journalThe Bone &amp; Joint Journal
dc.identifier.doi10.1302/0301-620x.105b9.bjj-2022-1343.r1
plymouth.organisational-group|Plymouth
plymouth.organisational-group|Plymouth|Research Groups
plymouth.organisational-group|Plymouth|Faculty of Health
plymouth.organisational-group|Plymouth|REF 2021 Researchers by UoA
plymouth.organisational-group|Plymouth|Users by role
plymouth.organisational-group|Plymouth|Users by role|Academics
plymouth.organisational-group|Plymouth|REF 2021 Researchers by UoA|UoA01 Clinical Medicine
plymouth.organisational-group|Plymouth|Faculty of Health|Peninsula Medical School
plymouth.organisational-group|Plymouth|Research Groups|FoH - Applied Parkinson's Research
plymouth.organisational-group|Plymouth|Users by role|Researchers in ResearchFish submission
plymouth.organisational-group|Plymouth|REF 2028 Researchers by UoA
plymouth.organisational-group|Plymouth|REF 2028 Researchers by UoA|UoA01 Clinical Medicine
dc.publisher.placeEngland
dc.date.updated2024-02-02T20:43:19Z
dc.rights.embargodate9999-12-31
dc.identifier.eissn2049-4408
dc.rights.embargoperiodforever
rioxxterms.versionofrecord10.1302/0301-620x.105b9.bjj-2022-1343.r1


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