Rating criteria of the causal nexus in Whiplash Associated DisordersA study of interrater reliability

  1. Carlos Represas-Vázquez
  2. Esteban Puente-López
  3. David Pina
  4. Aurelio Luna-Maldonado
  5. José Antonio Ruiz-Hernández
  6. Bartolomé Llor-Esteban
Journal:
Revista española de medicina legal: órgano de la Asociación Nacional de Médicos Forenses

ISSN: 0377-4732

Year of publication: 2021

Volume: 47

Issue: 2

Pages: 48-56

Type: Article

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DOI: 10.1016/J.REML.2020.06.002 DIALNET GOOGLE SCHOLAR

More publications in: Revista española de medicina legal: órgano de la Asociación Nacional de Médicos Forenses

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Abstract

Introduction The diagnosis of Whiplash Associated Disorders is subject to various criteria, some of a subjective nature, which impedes a high percentage of agreement among raters of the causal nexus. It is necessary to develop an evidence-based methodology to maximize the uniformity of this diagnosis. Our objective is to assess the interrater reliability of four experts in legal medicine who establish the causal nexus of traffic accident patients. Material and method 300 traffic accident patients evaluated by 4 legal medicine experts. They conducted two ratings, one without and one with a study of the biomechanics of the accident. The degree of concordance of the ratings was studied by the intraclass correlation coefficient (ICC) and the concordance index (CI). Results The results of both the intraclass correlation coefficient and the concordance index of the rating prior to the biomechanical study of the injury yield moderate-high values (ICC=.70; CI=.60). Likewise, the values observed in the rating with the study of biomechanics also indicate moderate-high agreement (ICC=.78, CI=.67). Conclusions The study of biomechanics slightly improves concordance. However, the aforementioned study does not help to reduce the proportion of doubtful cases and the levels of improvement are not acceptable. There are significant differences between the classifications, suggesting that the proposed valuation methodology is not uniform enough to reach a consensus.

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