Interobserver reliability of Pirani scoring for idiopathic clubfoot in walking-age children
Anil Agarwal1, Ashish Upadhyay, Varun Garg
1Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
Insights
The Pirani scoring system shows fair interobserver reliability for assessing walking-age idiopathic clubfoot. Further research is needed to develop more reliable assessment tools for this age group.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Clinical Assessment Tools
Background:
- The Pirani scoring system is widely used for clubfoot assessment in children under one year.
- Its reliability in older, walking-age children with idiopathic clubfoot is less understood.
Purpose of the Study:
- To evaluate the interobserver reliability of the Pirani scoring system in children over one year of age with idiopathic clubfoot.
- To compare Pirani scores assigned by pediatric orthopedic consultants and registrars.
Main Methods:
- Retrospective analysis of Pirani scores from 35 feet in 22 children (>1 year) with idiopathic clubfoot.
- Comparison of scores documented by consultants and registrars.
- Interobserver reliability calculated using Cohen's kappa.
Main Results:
- Overall Pirani score reliability was 'fair' (kappa = 0.3).
- Subcomponent reliability varied, with 'head of talus', 'rigid equinus', and 'lateral border' showing moderate reliability.
- Lower reliability was found for 'medial crease', 'posterior crease', and 'empty heel'.
- Registrars tended to score deformities as more severe than consultants.
Conclusions:
- The Pirani scoring system demonstrates only fair interobserver reliability in walking-age children with idiopathic clubfoot.
- Specific components like medial crease and posterior crease have low reliability.
- Development of more reliable assessment tools for older children with clubfoot is warranted.
Abstract:
Pirani scoring system is one of the most commonly used tools to assess the initial deformity, monitor the treatment progression, and identify relapse in clubfoot. The method has been demonstrated to correlate well with the sequential correction of deformity for children under age 1 year. We conducted a study to examine the interobserver reliability of Pirani scores in children of walking-age. The retrospective study focused on children >1 year age with idiopathic clubfoot presenting for primary treatment. The Pirani scores at presentation charted by pediatric orthopedic consultant and orthopedic registrars were compared and the intergroup reliability calculated using Cohen's kappa. Thirty-five feet in 22 clubfoot children (13 bilateral) were analyzed. The mean child's age was 3.9 years. The mean Pirani score for the consultant was 3.2 and for the registrars was 3.6. The overall reliability of Pirani score was 0.3 ('fair'). The highest reliability was calculated for the head of talus (0.55), rigid equinus (0.48), and lateral border (0.44) (moderate). A lower kappa was recorded for medial crease (0.28), posterior crease (0.34), and empty heel (0.4). The registrars graded the clubfoot deformity in the walking-age child as more severe compared to the consultant. The mean Pirani scores for medial and posterior crease subcomponents were low. Contrary to the common perception, empty heel manifested even in this age group. Looking to the statistics of 'fair' reliability of Pirani score for older child, further research is warranted to develop more reliable scores for assessment and treatment of clubfoot.
