• Mark J Lambrechts, Gregory D Schroeder, Brian A Karamian, Jose A Canseco, Richard Bransford, Cumhur Oner, Lorin M Benneker, Frank Kandziora, Rajasekaran Shanmuganathan, Rishi Kanna, Andrei F Joaquim, Jens R Chapman, Emiliano Vialle, Mohammad El-Sharkawi, Marcel Dvorak, Klaus Schnake, Christopher K Kepler, and Alexander R Vaccaro.
• Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.. Electronic address: mark.lambrechts@rothmanortho.com.
• Injury. 2022 Oct 1; 53 (10): 3248-3254.

PurposeTo assess the accuracy and reliability of the AO Spine Upper Cervical Injury Classification System based on a surgeons' work setting and trauma center affiliation.MethodsA total of 275 AO Spine members participated in a validation of 25 upper cervical spine injuries, which were evaluated by computed tomography (CT) scans. Each participant was grouped based on their work setting (academic, hospital-employed, or private practice) and their trauma center affiliation (Level I, Level II or III, and Level IV or no trauma center). The classification accuracy was calculated as percent of correct classifications, while interobserver reliability, and intraobserver reproducibility were evaluated based on Fleiss' Kappa coefficient.ResultsThe overall classification accuracy for surgeons affiliated with a level I trauma center was significantly greater than participants affiliated with a level II/III center or a level IV/no trauma center on assessment one (p1<0.0001) and two (p2 = 0.0003). On both assessments, surgeons affiliated with a level I or a level II/III trauma center were significantly more accurate at identifying IIIB injury types (p1 = 0.0007; p2 = 0.0064). Academic surgeons and hospital employed surgeons were significantly more likely to correctly classify type IIIB injuries on assessment one (p1 = 0.0146) and two (p2 = 0.0015). When evaluating classification reliability, the largest differences between work settings and trauma center affiliations was identified in type IIIB injuries.ConclusionType B injuries are the most difficult injury type to correctly classify. They are classified with greater reliability and classification accuracy when evaluated by academic surgeons, hospital-employed surgeons, and surgeons associated with higher-level trauma centers (I or II/III).Copyright © 2022 AO Foundation. Published by Elsevier Ltd.. All rights reserved.

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