scholarly journals The Classification of Long Bone Osteomyelitis: A Systemic Review of the Literature

2017 ◽  
Vol 2 (4) ◽  
pp. 167-174 ◽  
Author(s):  
Andrew J. Hotchen ◽  
Martin A. McNally ◽  
Parham Sendi
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
Classification System ◽  
Classification Systems ◽  
Bone Involvement ◽  
Long Bone ◽  
Soft Tissue Coverage ◽  
Host Status ◽  
Long Bone Osteomyelitis

Abstract. Background: Osteomyelitis is a complex disease. Treatment involves a combination of bone resection, antimicrobials and soft-tissue coverage. There is a difficulty in unifying a classification system for long bone osteomyelitis that is generally accepted.Objectives: In this systematic review, we aim to investigate the classification systems for long bone osteomyelitis that have been presented within the literature. By doing this, we hope to elucidate the important variables that are required when classifying osteomyelitis.Methods: A complete search of the Medline, EMBASE, Cochrane and Ovid databases was undertaken. Following exclusion criteria, 13 classification systems for long-bone osteomyelitis were included for review.Results: The 13 classification systems that were included for review presented seven different variables that were used for classification. Ten of them used only one main variable, two used two variables and one used seven variables. The variables included bone involvement (used in 7 classification systems), acute versus chronic infection (used in 6), aetiopathogenesis (used in 3), host status (used in 3), soft tissue (used in 2), microbiology (used in 1) and location of infected bone (used in 1). The purpose of each classification system could be grouped as either descriptive (3 classification systems), prognostic (4) or for management (4). Two of the 13 classification systems were for both prognostic and management purposes.Conclusions: This systematic review has demonstrated a variety of variables used for classification of long bone osteomyelitis. While some variables are used to guide management and rehabilitation after surgery (e.g., bone defect, soft tissue coverage), others were postulated to provide prognostic information (e.g., host status). Finally, some variables were used for descriptive purposes only (aetiopathogenesis). In our view and from today's perspective, bone involvement, antimicrobial resistance patterns of causative micro-organisms, the need for soft-tissue coverage and host status are important variables to include in a classification system.

Can we predict outcome after treatment of long bone osteomyelitis?

2020 ◽  
Vol 102-B (11) ◽  
pp. 1587-1596
Author(s):  
Andrew J. Hotchen ◽  
Maria Dudareva ◽  
Ruth A. Corrigan ◽  
Jamie Y. Ferguson ◽  
Martin A. McNally
Keyword(s):  
Soft Tissues ◽  
Surgical Debridement ◽  
Bone Involvement ◽  
Long Bone ◽  
Time Points ◽  
Patient Reported ◽  
Host Status ◽  
One Year ◽  
Long Bone Osteomyelitis ◽  
Eq Vas

Aims This study presents patient-reported quality of life (QoL) over the first year following surgical debridement of long bone osteomyelitis. It assesses the bone involvement, antimicrobial options, coverage of soft tissues, and host status (BACH) classification as a prognostic tool and its ability to stratify cases into ‘uncomplicated’ or ‘complex’. Methods Patients with long-bone osteomyelitis were identified prospectively between June 2010 and October 2015. All patients underwent surgical debridement in a single-staged procedure at a specialist bone infection unit. Self-reported QoL was assessed prospectively using the three-level EuroQol five-dimension questionnaire (EQ-5D-3L) index score and visual analogue scale (EQ-VAS) at five postoperative time-points (baseline, 14 days, 42 days, 120 days, and 365 days). BACH classification was applied retrospectively by two clinicians blinded to outcome. Results In total, 71 patients with long-bone osteomyelitis were included. There was significant improvement from time of surgery to one year postoperatively in mean EQ-VAS (58.2 to 78.9; p < 0.001) and mean EQ-5D-3L index scores (0.284 to 0.740; p < 0.001). At one year following surgery, BACH ‘uncomplicated’ osteomyelitis was associated with better QoL compared to BACH ‘complex’ osteomyelitis (mean EQ-5D-3L 0.900 vs 0.685; p = 0.020; mean EQ-VAS 87.1 vs 73.6; p = 0.043). Patients with uncomplicated bone involvement (BACH type B1, cavitary) reported higher QoL at all time-points when compared to complex bone involvement (B2, segmental or B3, osteomyelitis involving a joint). Patients with good antimicrobial options (Ax or A1) gave higher outcome scores compared to patients with multidrug-resistant isolates (A2). The need for microvascular tissue transfer (C1 and C2) did not impact significantly on QoL. Patients without major comorbidities (uncomplicated, H1) reported higher QoL compared to those with significant disease (complex, H2). Conclusion Uncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis. Cite this article: Bone Joint J 2020;102-B(11):1587–1596.

scholarly journals The BACH classification of long bone osteomyelitis

2019 ◽  
Vol 8 (10) ◽  
pp. 459-468 ◽  
Author(s):  
Andrew J. Hotchen ◽  
Maria Dudareva ◽  
Jamie Y. Ferguson ◽  
Parham Sendi ◽  
Martin A. McNally
Keyword(s):  
Classification Accuracy ◽  
Soft Tissues ◽  
Multidrug Resistant ◽  
Long Bone ◽  
Test Results ◽  
Clinical Imaging ◽  
The United Kingdom ◽  
Host Status ◽  
Long Bone Osteomyelitis

Objectives The aim of this study was to assess the clinical application of, and optimize the variables used in, the BACH classification of long-bone osteomyelitis. Methods A total of 30 clinicians from a variety of specialities classified 20 anonymized cases of long-bone osteomyelitis using BACH. Cases were derived from patients who presented to specialist centres in the United Kingdom between October 2016 and April 2017. Accuracy and Fleiss’ kappa (Fκ) were calculated for each variable. Bone involvement (B-variable) was assessed further by nine clinicians who classified ten additional cases of long bone osteomyelitis using a 3D clinical imaging package. Thresholds for defining multidrug-resistant (MDR) isolates were optimized using results from a further analysis of 253 long bone osteomyelitis cases. Results The B-variable had a classification accuracy of 77.0%, which improved to 95.7% when using a 3D clinical imaging package (p < 0.01). The A-variable demonstrated difficulty in the accuracy of classification for increasingly resistant isolates (A1 (non-resistant), 94.4%; A2 (MDR), 46.7%; A3 (extensively or pan-drug-resistant), 10.0%). Further analysis demonstrated that isolates with four or more resistant test results or less than 80% sensitive susceptibility test results had a 98.1% (95% confidence interval (CI) 96.6 to 99.6) and 98.8% (95% CI 98.1 to 100.0) correlation with MDR status, respectively. The coverage of the soft tissues (C-variable) and the host status (H-variable) both had a substantial agreement between users and a classification accuracy of 92.5% and 91.2%, respectively. Conclusions The BACH classification system can be applied accurately by users with a variety of clinical backgrounds. Accuracy of B-classification was improved using 3D imaging. The use of the A-variable has been optimized based on susceptibility testing results. Cite this article: A. J. Hotchen, M. Dudareva, J. Y. Ferguson, P. Sendi, M. A. McNally. The BACH classification of long bone osteomyelitis. Bone Joint Res 2019;8:459–468. DOI: 10.1302/2046-3758.810.BJR-2019-0050.R1

Can we predict outcome after treatment of long bone osteomyelitis?

2020 ◽  
pp. 1-10
Author(s):  
Andrew J. Hotchen ◽  
Maria Dudareva ◽  
Ruth A. Corrigan ◽  
Jamie Y. Ferguson ◽  
Martin A. McNally
Keyword(s):  
Soft Tissues ◽  
Surgical Debridement ◽  
Bone Involvement ◽  
Long Bone ◽  
Time Points ◽  
Patient Reported ◽  
Host Status ◽  
One Year ◽  
Long Bone Osteomyelitis ◽  
Eq Vas

Aims This study presents patient-reported quality of life (QoL) over the first year following surgical debridement of long bone osteomyelitis. It assesses the bone involvement, antimicrobial options, coverage of soft tissues, and host status (BACH) classification as a prognostic tool and its ability to stratify cases into ‘uncomplicated’ or ‘complex’. Methods Patients with long-bone osteomyelitis were identified prospectively between June 2010 and October 2015. All patients underwent surgical debridement in a single-staged procedure at a specialist bone infection unit. Self-reported QoL was assessed prospectively using the three-level EuroQol five-dimension questionnaire (EQ-5D-3L) index score and visual analogue scale (EQ-VAS) at five postoperative time-points (baseline, 14 days, 42 days, 120 days, and 365 days). BACH classification was applied retrospectively by two clinicians blinded to outcome. Results In total, 71 patients with long-bone osteomyelitis were included. There was significant improvement from time of surgery to one year postoperatively in mean EQ-VAS (58.2 to 78.9; p < 0.001) and mean EQ-5D-3L index scores (0.284 to 0.740; p < 0.001). At one year following surgery, BACH ‘uncomplicated’ osteomyelitis was associated with better QoL compared to BACH ‘complex’ osteomyelitis (mean EQ-5D-3L 0.900 vs 0.685; p = 0.020; mean EQ-VAS 87.1 vs 73.6; p = 0.043). Patients with uncomplicated bone involvement (BACH type B1, cavitary) reported higher QoL at all time-points when compared to complex bone involvement (B2, segmental or B3, osteomyelitis involving a joint). Patients with good antimicrobial options (Ax or A1) gave higher outcome scores compared to patients with multidrug-resistant isolates (A2). The need for microvascular tissue transfer (C1 and C2) did not impact significantly on QoL. Patients without major comorbidities (uncomplicated, H1) reported higher QoL compared to those with significant disease (complex, H2). Conclusion Uncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis.

scholarly journals Is the AO spine thoracolumbar injury classification system reliable and practical? a systematic review

2021 ◽  
Vol 87 (1) ◽  
pp. 181-190
Author(s):  
Zion Hwang ◽  
James Houston ◽  
Evangelos M. Fragakis ◽  
Cristina Lupu ◽  
Jason Bernard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Classification System ◽  
Data Extraction ◽  
Cochrane Collaboration ◽  
Classification Systems ◽  
Science Data ◽  
Thoracolumbar Injury ◽  
Type Classification ◽  
Injury Classification

Controversy surrounding the classification of thoracolumbar injuries has given rise to various classification systems over the years, including the most recent AOSpine Thoracolumbar Injury Classification System (ATLICS). This systematic review aims to provide an up-to-date evaluation of the literature, including assessment of a further three studies not analysed in previous reviews. In doing so, this is the first systematic review to include the reliability among non-spine subspecialty professionals and to document the wide variety between reliability across studies, particularly with regard to sub-type classification. Relevant studies were found via a systematic search of PubMed, EBESCO, Cochrane and Web of Science. Data extraction and quality assessment were conducted in line with Cochrane Collaboration guidelines. Twelve articles assessing the reliability of ATLICS were included in this review. The overall inter-observer reliability varied from fair to substantial, but the three additional studies in this review, compared to previous reviews, presented on average only fair reliability. The greatest variation of results was seen in A1 and B3 subtypes. Least reliably classified on average was A4 subtype. This systematic review concludes that ATLICS is reliable for the majority of injuries, but the variability within subtypes suggests the need for further research in assessing the needs of users in order to increase familiarity with ATLICS or perhaps the necessity to include more subtype-specific criteria into the system. Further research is also recommended on the reliability of modifiers, neurological classification and the application of ATLICS in a paediatric context.

Management of Gustilo–Anderson IIIB open tibial fractures in adults—a systematic review

2021 ◽  
Author(s):  
A Myatt ◽  
H Saleeb ◽  
G A J Robertson ◽  
Jana Keren Bourhill ◽  
P R J Page ◽  
...  
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
Pragmatic Trial ◽  
Deep Infection ◽  
Tibial Fractures ◽  
High Rate ◽  
Long Bone ◽  
Soft Tissue Coverage ◽  
Muscle Flaps ◽  
Open Tibial Fractures

Abstract Introduction Open tibial fractures are the most common open long bone fracture, despite this, the management of these complex injuries still remains a topic of discussion amongst orthopaedic surgeons. Sources of data We searched the EMBASE, MEDLINE and Google Scholar and a systematic review of 7500 articles, leaving 23 after exclusion criteria were applied, in order to analyse the management of open tibial fractures. Areas of agreement and controversy Infection was noted to be the most significant concern amongst authors, with definitive external fixation having a high rate of superficial pin-site infection and internal fixation having a high deep infection rate. Growing points It is essential to have a combined ortho-plastic approach to the management of these fractures as muscle flaps were the most common form of soft tissue coverage. Areas timely for developing research A national pragmatic trial into the management of open tibial fractures is required looking at fixation methods and soft tissue coverage, with at least a 2-year follow-up in order to ascertain the most appropriate management of these fractures and patient-related outcomes.

scholarly journals Toward the Development of a Comprehensive Clinically Oriented Patient Profile: A Systematic Review of the Purpose, Characteristic, and Methodological Quality of Classification Systems of Adult Spinal Deformity

Neurosurgery ◽  
2021 ◽  
Author(s):  
Kenny Yat Hong Kwan ◽  
J Naresh-Babu ◽  
Wilco Jacobs ◽  
Marinus de Kleuver ◽  
David W Polly ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Classification System ◽  
Methodological Quality ◽  
Literature Search ◽  
Adult Spinal Deformity ◽  
Classification Systems ◽  
Systematic Literature Search ◽  
Patient Profile

Abstract BACKGROUND Existing adult spinal deformity (ASD) classification systems are based on radiological parameters but management of ASD patients requires a holistic approach. A comprehensive clinically oriented patient profile and classification of ASD that can guide decision-making and correlate with patient outcomes is lacking. OBJECTIVE To perform a systematic review to determine the purpose, characteristic, and methodological quality of classification systems currently used in ASD. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science for literature published between January 2000 and October 2018. From the included studies, list of classification systems, their methodological measurement properties, and correlation with treatment outcomes were analyzed. RESULTS Out of 4470 screened references, 163 were included, and 54 different classification systems for ASD were identified. The most commonly used was the Scoliosis Research Society-Schwab classification system. A total of 35 classifications were based on radiological parameters, and no correlation was found between any classification system levels with patient-related outcomes. Limited evidence of limited quality was available on methodological quality of the classification systems. For studies that reported the data, intraobserver and interobserver reliability were good (kappa = 0.8). CONCLUSION This systematic literature search revealed that current classification systems in clinical use neither include a comprehensive set of dimensions relevant to decision-making nor did they correlate with outcomes. A classification system comprising a core set of patient-related, radiological, and etiological characteristics relevant to the management of ASD is needed.

Evolution of Hotel Classification System in Russian Federation

2021 ◽  
Vol 12 (1) ◽  
pp. 277
Author(s):  
Dmitry Aleksandrovich KOZLOV
Keyword(s):  
Russian Federation ◽  
Classification System ◽  
State Standards ◽  
Classification Systems ◽  
International Standards ◽  
Economic Activities ◽  
World Tourism Organization ◽  
The Russian Federation ◽  
Tourism Organization

The main aim of this paper is to analyze the approaches to the system of classification of accommodation facilities in the Russian Federation. The United Nations World Tourism Organization pays great attention to the unification of classification systems for accommodation facilities in all countries of the world, issuing appropriate recommendations on tourism statistics systems, classification of economic activities, as well as criteria for interregional harmonization. In the Russian Federation, there are a number of laws, regulations, state standards, building and sanitary norms and rules concerning the classification of accommodation facilities. They are so imperfect that they have to be revised almost annually or even several times a year. The general statistics of accommodation facilities currently do not correspond to world recommendations. The classification system needs to be revised and brought into line with international standards as much as possible.

scholarly journals Proposal of a new classification scheme for periocular injuries

2017 ◽  
Vol 50 (01) ◽  
pp. 021-028 ◽  
Author(s):  
Devi Prasad Mohapatra ◽  
Friji Meethale Thiruvoth ◽  
Ravi Kumar Chittoria ◽  
S. Dinesh Kumar ◽  
Sudhanva Hemant Kumar ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Classification Scheme ◽  
Soft Tissue Injuries ◽  
Classification Systems ◽  
Lateral Canthus ◽  
Aesthetic Appearance ◽  
Adjacent Structures ◽  
Tissue Injuries ◽  
Comprehensive Classification

ABSTRACT Background: Eyelids are important structures and play a role in protecting the globe from trauma, brightness, in maintaining the integrity of tear films and moving the tears towards the lacrimal drainage system and contribute to aesthetic appearance of the face. Ophthalmic trauma is an important cause of morbidity among individuals and has also been responsible for additional cost of healthcare. Periocular trauma involving eyelids and adjacent structures has been found to have increased recently probably due to increased pace of life and increased dependence on machinery. A comprehensive classification of periocular trauma would help in stratifying these injuries as well as study outcomes. Material and Methods: This study was carried out at our institute from June 2015 to Dec 2015. We searched multiple English language databases for existing classification systems for periocular trauma. We designed a system of classification of periocular soft tissue injuries based on clinico-anatomical presentations. This classification was applied prospectively to patients presenting with periocular soft tissue injuries to our department. Results: A comprehensive classification scheme was designed consisting of five types of periocular injuries. A total of 38 eyelid injuries in 34 patients were evaluated in this study. According to the System for Peri-Ocular Trauma (SPOT) classification, Type V injuries were most common. SPOT Type II injuries were more common isolated injuries among all zones. Discussion: Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. The SPOT classification has taken into account the periocular soft tissue injuries i.e., upper eyelid, lower eyelid, medial and lateral canthus injuries., based on observed clinico-anatomical patterns of eyelid injuries. Conclusion: The SPOT classification seems to be a reliable system to address eyelid injuries. This classification scheme would guide the ophthalmic and facial reconstructive surgeons to provide optimal outcomes in eyelid injuries. Based on the classification scheme and review of existing literature, an algorithm is presented to facilitate repair and reconstruction.

scholarly journals Classification and treatment of endothermal heat-induced thrombosis: Recommendations from the American Venous Forum and the Society for Vascular Surgery This Practice Guidelines document has been co-published in Phlebology [DOI: 10.1177/0268355520953759] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.06.008]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal’s style. The contribution has been published under a Attribution-Non Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0), (https://creativecommons.org/licenses/by-nc-nd/4.0/).

2020 ◽  
pp. 026835552095375
Author(s):  
Lowell S. Kabnick ◽  
Mikel Sadek ◽  
Haraldur Bjarnason ◽  
Dawn M. Coleman ◽  
Ellen D. Dillavou ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Classification System ◽  
Treatment Guidelines ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Duplex Ultrasound ◽  
Classification Systems ◽  
The Body ◽  
The Novel

The American Venous Forum (AVF) and the Society for Vascular Surgery set forth these guidelines for the management of endothermal heat-induced thrombosis (EHIT). The guidelines serve to compile the body of literature on EHIT and to put forth evidence-based recommendations. The guidelines are divided into the following categories: classification of EHIT, risk factors and prevention, and treatment of EHIT. One major feature is to standardize the reporting under one classification system. The Kabnick and Lawrence classification systems are now combined into the AVF EHIT classification system. The novel classification system affords standardization in reporting but also allows continued combined evaluation with the current body of literature. Recommendations codify the use of duplex ultrasound for the diagnosis of EHIT. Risk factor assessments and methods of prevention including mechanical prophylaxis, chemical prophylaxis, and ablation distance are discussed. Treatment guidelines are tailored to the AVF EHIT class (ie, I, II, III, IV). Reference is made to the use of surveillance, antiplatelet therapy, and anticoagulants as deemed indicated, and the recommendations incorporate the use of the novel direct oral anticoagulants. Last, EHIT management as it relates to the great and small saphenous veins is discussed.

scholarly journals The Logic Behind the Classification of Sciences in the Arab-Islamic Classification Systems: with the Modern Western Classification Systems An Analytical Comparative Reading

2016 ◽  
Vol 7 (3) ◽  
pp. 69
Author(s):  
Nahed Mohamad Basyoni Salem
Keyword(s):  
Analytical Method ◽  
Classification System ◽  
Classification Systems ◽  
Library Of Congress ◽  
Scientific Methods ◽  
Rules And Principles ◽  
Modern Classification ◽  
Decimal Classification

This study aimed to explore the rules and principles adopted in the Arab-Islamic Classification Systems and tried to identify their scientific methods to determine the relations between sciences. The study followed the comparative analytical method to analyze and compare the Arab-Islamic Classification Systems with the Western modern ones represented in the Dewey Decimal Classification System and the Library of Congress Classification System. The research tries to explore the logic behind classification of sciences in the Arab-Islamic Classification Systems. The findings revealed that the Arab-Islamic Classification Systems follow the same rules and principles of modern classification systems and their types are represented in the types of modern Western classification systems. The study recommends the need to conduct research on the Arab-Islamic Classification Systems and introduce it. 

Sign in / Sign up

Export Citation Format

Share Document