Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists' reports and surgeons' assessments?

Objectives: Cobb angle is a standard method for quantification of scoliosis in adolescent idiopathic scoliosis to guide treatment decisions. Precise and timely curve detection can ensure early referrals, amenable for bracing. Radiology reports serve as a guiding tool for family physicians to expedite specialist referrals. Therefore, accurate and reliable measurement of Cobb angle at the community level is crucial. This retrospective study investigated the agreement in Cobb angle measurement between radiologists and spine surgeons.

Methods: Eighty radiographic reports (Cobb angle, Risser stage, and end vertebrae selection) completed by radiologists and spine surgeons were compared. To assess interrater reliability, interclass correlation coefficients (ICC) with 95% confidence intervals (CIs) were computed. ICC < 0.70, 0.70 to 0.79, 0.80 to 89, and 0.9 to 0.99 were considered poor, fair, good, and excellent reliability, respectively. All radiographs were assessed for quality.

Results: The agreement between spine surgeons and radiologists was poor (ICC = 0.65, 95% CI: 0.13 to 0.97). The agreement between spine surgeons and community radiologists was poor (ICC = 0.45, 95% CI: 0.17 to 0.66). Risser stage was not reported in 56 of the 80 reports. ICC between spine surgeons and radiologists for the Risser stage was poor (ICC = 0.625, 95% CI: 0.325 to 0.794). For end vertebrae identification, there was absolute agreement of end vertebrae identification in 23 of the 80 scans.

Conclusions: This study demonstrated a significant disagreement in scoliosis measurement between radiologists and spine surgeons, which significantly impacts appropriateness of referrals. Methods to improve triaging using allied health professional (i.e., nurse practitioners) may help ensure that patients presenting with scoliosis are referred in a timely manner.