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The simplified skeletal maturity scoring (SSMS) system shows excellent intraobserver reliability, improving with experience. Interobserver agreement is substantial but does not improve with familiarity, with most disagreements within one stage.

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Area of Science:

  • Orthopedics
  • Radiology
  • Skeletal Maturity Assessment

Background:

  • The simplified skeletal maturity scoring (SSMS) system is utilized for predicting curve progression in idiopathic scoliosis.
  • Validation of the SSMS system's reliability is crucial for its consistent application in clinical practice.

Purpose of the Study:

  • To validate the intra- and interobserver reliability of the SSMS system in a large cohort.
  • To assess reliability across different stages and for the overall cohort.

Main Methods:

  • Retrospective review of 275 hand radiographs from patients aged 8-16 years.
  • Five independent observers with varying experience levels scored images twice using the SSMS (stages 1-8).
  • Intraobserver agreement was assessed using Pearson and Spearman correlation coefficients; interobserver agreement was assessed using Fleiss κ coefficient.

Main Results:

  • Excellent intrarater reliability was observed, with scores ranging from 0.956 to 0.998, improving with observer experience.
  • Substantial inter-rater reliability (κ = 0.65-0.66) was found, with no significant improvement noted with increased experience.
  • Most disagreements (98%) were within a single stage, primarily involving stages 2, 3, and 4, with stage 3 being the most frequent.

Conclusions:

  • The SSMS system demonstrates excellent intraobserver agreement, which is enhanced by familiarity with the system.
  • Substantial interobserver agreement is present, though it does not improve with experience.
  • Potential biases, such as expectancy bias towards SSMS stage 3, and the need for clearer descriptions for stages 2 and 3 were identified.