Interobserver Reliability of Cervical Vertebral Maturation Staging

Abstract

Background: the accurate identification of a patient's maturation stage, particularly during the pubertal growth spurt, takes on heightened importance, particularly when addressing cases of dentoskeletal problem Active growth determination is crucial for orthodontic treatment. Objectives: The objective of this study was to determine interobserver reliability of Cervical Vertebrae Maturation (CVM) stagingMaterial and Methods: This cross-sectional correlational study, conducted in the Department of Orthodontics on 70 subjects. Ten orthodontic clinicians, including 4 orthodontists and 6 orthodontic residents, with no prior experience in CVM staging, underwent comprehensive training. The study involved assessing 70 lateral cephalograms with clear visibility of cervical vertebrae, evaluated by two independent examiners using the Baccetti et al. staging system. The collected data were analyzed using R programming, including descriptive statistics for age, Spearman's correlation, and Cohen's Kappa for assessing interobserver agreement, with stratification by gender. Results: The mean age of participants was 12.60±3.93 years, with 38 females (54.29%) and 32 males (45.71%). The study revealed varying levels of agreement between two observers for different CVM stages, ranging from perfect agreement in CS1 to strong agreement in CS3. CS4, CS5, and CS6 also showed varying agreement rates. Additionally, there was robust and statistically significant agreement (p<0.001) between observers in cervical maturation staging, supported by a high Spearman's rho value (r=0.927). Furthermore, substantial agreement was observed with a Kappa value of 0.748, indicating a strong consensus in cervical staging assessments.Conclusion: Cervical vertebral maturation staging is reliable in term of inter-observers agreement. Keywords: Cervical vertebral maturation, Interobserver agreement, Growth assessment