Title :

What is the clinical detection threshold for lower limb length inequality? In silico study of reproducibility and optimization using a centimeter graduated support

Author(s) :

Erivan, Roger [Auteur]
Institut de Chimie de Clermont-Ferrand [ICCF]
SIGMA Clermont [SIGMA Clermont]
Urbain, Antoine [Auteur]
Hôpital Roger Salengro [Lille]
Université de Lille
Santorum, Tony [Auteur]
Université de Lille
Giordano, Gérard [Auteur]
Hôpital Joseph Ducuing - Varsovie [Toulouse] [HJD]
Reina, Nicolas [Auteur]
Centre Hospitalier Universitaire de Toulouse [CHU Toulouse]
Bonnomet, François [Auteur]
Hôpital de Hautepierre [Strasbourg]
Jenny, Jean Yves [Auteur]
Peuchot, Henri [Auteur]
Centre Hospitalier d'Aix en Provence [Aix-en-Provence] [CHIAP ]
Bonin, Nicolas [Auteur]
Hormi--Menard, Mehdi [Auteur]
Hôpital Roger Salengro [Lille]
Université de Lille
Miletic, Bruno [Auteur]
Ramsay Générale de Santé - Hôpital Privé La Louvière
Wegrzyn, Julien [Auteur]
Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne] [CHUV]
Université de Lausanne = University of Lausanne [UNIL]
Razanabola, Fredson [Auteur]
Centre Hospitalier Régional d'Orléans [CHRO]
Jardin, Christophe [Auteur]
Clinique des Ormeaux - Centre médico-chirurgical
Nieto, Hervé [Auteur]
Centre Hospitalier Georges Renon [Niort] [CH Georges Renon Niort]
Loubignac, François [Auteur]
Matsoukis, Jean [Auteur]
Groupe Hospitalier du Havre
Hardy, Jérémy [Auteur]
Hôpital Dupuytren [CHU Limoges]
Duhamel, Alain [Auteur]
Hôpital Roger Salengro [Lille]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Université de Lille
Migaud, Henri [Auteur]
Hôpital Roger Salengro [Lille]
Université de Lille

Journal title :

Orthopaedics & Traumatology: Surgery & Research

Abbreviated title :

Orthop Traumatol Surg Res

Pages :

103981

Publisher :

Elsevier

Publication date :

2024-08-28

ISSN :

1877-0568

English keyword(s) :

Lower limb length inequality
In silico study
Clinical measurement

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Introduction The threshold of a Leg Length Discrepancy (LLD) by clinical examination on a sheet or centimeter paper (CP) is not known precisely whether or not it concerns limbs equipped with a hip prosthesis. We therefore ...
Show more >Introduction The threshold of a Leg Length Discrepancy (LLD) by clinical examination on a sheet or centimeter paper (CP) is not known precisely whether or not it concerns limbs equipped with a hip prosthesis. We therefore conducted a prospective in silico study in order to: (1) determine the reproducibility and sensitivity of the clinical measurement of the LLD in different ideal and "degraded" clinical situations, (2) determine the threshold from which the human eye is capable of detecting a length inequality in clinic, (3) to determine whether the use of a graduated support (centimeter paper) improves the clinical measurement threshold. Hypothesis Our hypothesis was that clinical measurement on a centimeter support would improve clinical measurement accuracy. Material and methods This was an in silico study, the experiment was conducted on a mannequin. Different inequalities were created on a mannequin and photographed with a total of 30 inequalities from −22 to +22 mm on sheet or centimeter paper (CP). This was a multicenter study, with 40 different readers. We asked the readers to make a second measurement one month later. We evaluated the inter- and intra-observer reproducibility. The error rate at the threshold of 3 mm and 5 mm were calculated versus the gold standard. Finally, we determined at which thresholds respectively 75% and 95% of the measurements were correct. Results A total of 4140 measurements were performed and compared to the gold standard. With a threshold of 75% accurate measurement, the LLD detection threshold was 2.8 mm on centimeter paper and 4.5 mm on sheet. With a threshold of 95% accurate measurement, the LLD detection threshold was 3.4 mm on centimeter paper and 5.2 mm on sheet. Interobserver agreement (assessed overall on the 40 observers by Krippendorff's generalized Kappa) was 0.86 (95% confidence interval (CI95%) = 0.79 to 0.92) on CP and 0.71 (CI95% = 0.63 to 0.79) on sheet. Intra-observer agreement assessed by the intraclass correlation coefficient among observers who made 2 measurements had a median value (IQR) of 0.96 (0.94 to 0.99) on CP and 0.90 (0.83 to 0.94) on sheet. Discussion The clinical detection threshold on sheet at the patient's bed appears close to 5 mm. A more precise measurement is possible with graduated centimeter paper. A study in daily practice on patients in real situations would confirm our results. Level of evidence III; prospective diagnostic comparative in Silico study.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
CHU Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2024-10-17T21:03:33Z
2024-10-30T13:44:50Z