The Reliability of a Grading System for Digital Subtraction Imaging Quality During Cervical Transforaminal Epidural Steroid Injection

Author:

Binler Danielle1,House L McLean1,Mattie Ryan2,Saltychev Mikhail3,Nagao Masato4,Pekmeczi Murat4,Metz Lionel4,O’Neil Conor4,Shah Vinil5,McCormick Zachary L6

Affiliation:

1. Department of Anesthesia & Perioperative Care, University of California San Francisco, San Francisco, California

2. Providence Cedars-Sinai Tarzana Medical Center, Interventional Spine and Pain Management, Tarzana, California, USA

3. Department of Physical Medicine and Rehabilitation, Turku University Hospital and University of Turku, Turku, Finland

4. Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California

5. Department of Radiology, University of California San Francisco, San Francisco, California

6. Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA

Abstract

Abstract Objective Digital subtraction imaging (DSI) decreases the risk of intravascular injection during cervical transforaminal epidural steroid injection (CTFESI); however, sequence acquisition and interpretation are operator-dependent skills. This study tests the reliability of a grading system to determine adequate DSI during CTFESI. Setting Academic tertiary medical center. Methods A grading scheme for adequate DSI quality during CTFESI was created by the study authors based on patient positioning, mask image, and volume of contrast injected. The inter-rater and intrarater reliability values of this grading scheme were tested using 50 DSI images evaluated by three raters during two distinct sessions separated by four weeks. Based on a power analysis, a sample of 50 scans was sufficient to detect significant correlations. Inter-rater reliability was determined by percent agreement between graders for dichotomized categories of “quality of DSI is adequate for safe C-TFESI” vs “quality of DSI is inadequate for safe C-TFESI.” The percentage of agreement was reported, along with Gwet’s agreement coefficient (AC). The intrarater (pre/post) correlation was assessed using Yule’s Q statistics. Results Correlation coefficients were interpreted as follows: 0.00–0.19 “very weak,” 0.20–0.39 “weak,” 0.40–0.59 “moderate,” 0.60–0.79 “strong,” and 0.80–1.00 “very strong.” Inter-rater reliability analyses demonstrated that the patient position category had “very strong” agreement, contrast volume had “strong” agreement, and mask image had “moderate” agreement. The overall inter-rater reliability was “moderate.” All of the raters demonstrated “very strong” intrarater reliability. Conclusions The proposed grading system for adequate-quality DSI during CTFESI showed overall “moderate” and “very strong” inter- and intrarater reliability, respectively. This scheme provides an objective measure of DSI quality for CTFESI. Refinement is needed to improve the reliability of this scheme.

Publisher

Oxford University Press (OUP)

Subject

Anesthesiology and Pain Medicine,Clinical Neurology,General Medicine

Reference14 articles.

1. Cervical epidural steroid injection: Techniques and evidence;House;Phys Med Rehabil Clin N Am,2018

2. The effectiveness and risks of fluoroscopically guided cervical transforaminal injections of steroids: A systematic review with comprehensive analysis of the published data;Engel;Pain Med,2014

3. The effectiveness of fluoroscopically-guided cervical transforaminal epidural steroid injection for the treatment of radicular pain; a systematic review and meta-analysis;Conger;Pain Med

4. Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery;Rozin;Am J Forensic Med Pathol,2003

5. Complications of cervical selective nerve root blocks performed with fluoroscopic guidance;Wallace;Am J Roentgenol,2007

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3