Agreement in Metastatic Spinal Cord Compression

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  • a From the Department of Radiology, Valencian Oncology Institute Foundation, Valencia, Spain; Research Institute in Health Services Foundation, Valencia, Spain; Spanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca, Spain; Scientific Department, Kovacs Foundation, Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; Department of Radiology, Hospital Regional Universitario Carlos Haya, Málaga, Spain; Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain; and Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
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Background: Metastatic epidural spinal cord compression (ESCC) is a devastating medical emergency. The purpose of this study was to determine the reliability of the 6-point ESCC scoring system and the identification of the spinal level presenting ESCC. Methods: Clinical data and imaging from 90 patients with biopsy-proven spinal metastases were provided to 83 specialists from 44 hospitals. The spinal levels presenting metastases and the ESCC scores for each case were calculated twice by each clinician, with a minimum of 6 weeks' interval. Clinicians were blinded to assessments made by other specialists and their own previous assessment. Fleiss kappa (κ) statistic was used to assess intraobserver and interobserver agreement. Subgroup analyses were performed according to clinicians' specialty (medical oncology, neurosurgery, radiology, orthopedic surgery, and radiation oncology), years of experience, and type of hospital. Results: Intraobserver and interobserver agreement on the location of ESCC was substantial (κ>0.61). Intraobserver agreement on the ESCC score was “excellent” (κ=0.82), whereas interobserver agreement was substantial (κ=0.64). Overall agreement with the tumor board classification was substantial (κ=0.71). Results were similar across specialties, years of experience and hospital category. Conclusions: The ESCC score can help improve communication among clinicians involved in oncology care.

The view members of the Spanish Back Pain Research Network Task Force, see supplemental eAppendix 1 (available with this issue, at

Correspondence: Estanislao Arana, MD, MHE, PhD, Fundación Instituto Valenciano de Oncología, C/ Beltrán Báguena, 19, 46009 Valencia, Spain. E-mail:

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