Interobserver and Intraobserver Reproducibility and Reliability of the Huashan Clinical Classification System for Hirayama Disease

Chi Sun; Guangyu Xu; Yuxuan Zhang; Zhongyi Cui; Dayong Liu; Yong Yang; Xiandi Wang; Xiaosheng Ma; Feizhou Lu; Jianyuan Jiang; Hongli Wang

doi:10.3389/fneur.2021.779438

Interobserver and Intraobserver Reproducibility and Reliability of the Huashan Clinical Classification System for Hirayama Disease

Front Neurol. 2021 Dec 3:12:779438. doi: 10.3389/fneur.2021.779438. eCollection 2021.

Authors

Chi Sun¹, Guangyu Xu¹, Yuxuan Zhang¹, Zhongyi Cui¹, Dayong Liu², Yong Yang³, Xiandi Wang⁴, Xiaosheng Ma¹, Feizhou Lu¹, Jianyuan Jiang¹, Hongli Wang¹

Affiliations

¹ Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China.
² Department of Spine Surgery, Weifang People's Hospital, Weifang Medical University, Weifang, China.
³ Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.
⁴ Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.

Abstract

Purpose: The Huashan clinical classification system for Hirayama disease has recently been proposed and has been found useful for diagnosis and treatment. So far, however, there has been little in-depth evaluation of its reliability. Thus, this study aimed to assess the reproducibility and reliability of the system. Methods: Patients diagnosed with Hirayama disease between 2019 and 2020 were recruited. Seven spine surgeons from four different institutions, including an experienced group of three and an inexperienced group of four, were trained as observers of the Huashan clinical classification system for Hirayama disease, and these surgeons classified the recruited patients using the system. Then, 2 months later, they repeated the classification on the same patients in a different order. The interobserver and intraobserver agreement between the results was analyzed using percentage agreement and weighted kappa (κ) statistics. Results: A total of 60 patients were included in the analysis. For all the observers, experienced observers, and inexperienced observers, the agreement percentages were, respectively, 78.5% (κ = 0.76), 80.0% (κ = 0.78), and 78.9% (κ = 0.77), indicating substantial interobserver reproducibility. For distinguishing typical (Types I and II) and atypical (Type III) Hirayama disease among the different groups of observers, the percentage agreement ranged from 95.6 to 98.9% (κ = 0.74-0.92), indicating substantial to nearly perfect reproducibility. For suggesting conservative treatment (Types I and III) or surgery (Type II), the percentage agreement ranged from 93.3 to 96.4% (κ = 0.81-0.90), indicating nearly perfect reproducibility. As for intraobserver agreement, the percentage agreement ranged from 68.3 to 81.7% (κ = 0.65-0.79), indicating substantial reliability. Conclusion: The Huashan clinical classification system for Hirayama disease was easy to learn and apply in a clinical environment, showing excellent reproducibility and reliability. Therefore, it would be promising to apply and promote this system for the precise and individualized future treatment of Hirayama disease.

Keywords: Hirayama disease; cervical spine; classification; reliability; reproducibility.