Reliability of the Spinal Instability Neoplastic Score (SINS) among radiation oncologists: an assessment of instability secondary to spinal metastases
Year: 2014
Type: article
Abstract: BACKGROUND: The Spinal Instability Neoplastic Score (SINS) categorizes tumor related spinal instability. It has the potential to streamline the referral of patients with established or potential spinal instability to a spine surgeon. This study aims to define the inter- and intra-observer reliability and validity of SINS among radiation oncologists. METHODS: Thirty-three radiation oncologists, across ten international sites, rated 30 neoplastic spinal disease cases. For each case, the total SINS (0-18 points), three clinical categories (stable: 0-6 points, potentially unstable: 7-12 points, and unstable: 13-18 points), and a binary scale ('stable': 0-6 points and 'current or possible instability'; surgical consultation recommended: 7-18 points) were recorded. Evaluation was repeated 6-8 weeks later. Inter-observer agreement and intra-observer reproducibility were calculated by means of the kappa statistic and translated into levels of agreement (slight, fair, moderate, substantial, and excellent). Validity was determined by comparing the ratings against a spinal surgeon's consensus standard. RESULTS: Radiation oncologists demonstrated substantial (κ=0.76) inter-observer and excellent (κ=0.80) intra-observer reliability when using the SINS binary scale ('stable' versus 'current or possible instability'). Validity of the binary scale was also excellent (κ=0.85) compared with the gold standard. None of the unstable cases was rated as stable by the radiation oncologists ensuring all were appropriately recommended for surgical consultation. CONCLUSIONS: Among radiation oncologists SINS is a highly reliable, reproducible, and valid assessment tool to address a key question in tumor related spinal disease: Is the spine 'stable' or is there 'current or possible instability' that warrants surgical assessment?
Source: Radiation Oncology
Institutions: Vancouver Coastal Health, University of British Columbia, Christchurch Hospital, University Medical Center Utrecht, Istituto Ortopedico Rizzoli, Buda Health Center, National Center for Spinal Disorders, The University of Texas MD Anderson Cancer Center, Kanazawa Medical University, Royal University Hospital, University of Saskatchewan, BC Cancer Agency, University of Oxford, Oxford University Hospitals NHS Trust, Sunnybrook Health Science Centre, University of Toronto, Princess Margaret Cancer Centre, Toronto Western Hospital, Johns Hopkins University, Johns Hopkins Medicine
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,290
OpenAlex ID: W2139782887