Abstract
Five surgeons independently rated clinical photographs of forty patients with AIS. Ratings of shoulder blades, shoulder symmetry, and waist symmetry were related to “overall appearance”, and were also correlated with rib prominence and Cobb angle. Because the components of surgeons’ ratings of appearance differed, this may lead to inconsistent recommendations regarding surgery.
To identify patient characteristics associated with surgeons’ ratings of patient physical deformity in Adolescent Idiopathic Scoliosis (AIS).
Five surgeons independently rated clinical photographs of forty patients with AIS. Surgeons separately rated the appearance of patients’ shoulder blades, shoulder symmetry, waist symmetry and also rated their “overall appearance” [in five categories from zero (best) to five (worst)]. The following clinical and radiographic data was also collected: rib prominence, vertebral rotation, shoulder height, spinal imbalance, Cobb angle, age, sex, and body mass index.
Surgeons’ mean rating for “overall appearance” was moderately correlated with rib prominence (r = 0.48), vertebral rotation (r = 0.44) and Cobb angle (r = 0.53). Surgeons’ rating of patients’ “overall appearance” was affected by each of: shoulder blades (p = 0.001), shoulder symmetry (p = 0.01) and waist symmetry (p = 0.001). However, each surgeon weighted components of patients’ appearance differently to arrive at their overall rating of appearance (p< 0.006).
Because patients’ physical appearance is an important element of surgical decision making, differences among surgeons could be contributing to inconsistent recommendations.
Surgeons’ ratings of physical appearance are based on surgeons’ ratings of patients’ shoulder blades, waist symmetry and shoulder symmetry but surgeons weight those elements differently.
Surgeon decision making is complicated. It is based on radiographs and subjective assessment. Patients’ appearance undoubtedly influences surgeon recommendation for surgery. We need to clarify surgeons’ ratings and improve the criteria for surgeon decision making.
Funding: This trial was funded by (in alphabetical order) The Canadian Institutes of Health Research, DePuyAcroMed-Johnson & Johnson Medical Products, and Synthes, Canada.
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
