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Original Investigation |

Interreader Variability of Computed Tomography for Orbital Floor Fracture

Matthew G. Vicinanzo, MD1,2; Gerald McGwin Jr, MS, PhD1,3; Chaitanya Allamneni, BA4; John A. Long, MD1,2
[+] Author Affiliations
1Department of Ophthalmology, University of Alabama at Birmingham, Birmingham
2Alabama Ophthalmology Associates, Birmingham
3Department of Epidemiology, University of Alabama at Birmingham, Birmingham
4University of Alabama School of Medicine, Birmingham
JAMA Ophthalmol. 2015;133(12):1393-1397. doi:10.1001/jamaophthalmol.2015.3501.
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Importance  The timing and indications for repair of orbital floor fractures have been controversial. Current practice dictates that fractures involving more than 50% of the orbital floor should be repaired. Early management is initiated in such situations to prevent long-term sequelae of enophthalmos and diplopia. Because fracture size as measured by computed tomography (CT) is one of the criteria to determine the need for surgical repair, there is a need to know the reliability of this parameter.

Objective  To assess the variability of CT measurements of orbital floor fractures.

Design, Setting, and Participants  This study took place between January 1, 2005, and June 1, 2007, at an urban academic medical center. Patients with isolated orbital floor fractures were evaluated by 1 oculoplastic surgeon, and their orbital CT images were subsequently read by 3 neuroradiologists blinded to demographic information and the other readers’ measurements. Separately, each was asked to determine the maximal anterior to posterior length and transverse width if a floor fracture existed.

Main Outcomes and Measures  Intraclass correlation coefficients were calculated for length and width using a 2-way mixed-effects model to evaluate the agreement between radiologists.

Results  Twenty-three patients met criteria for inclusion in this study (isolated orbital fracture thought to be in need of repair, with diplopia within 30° of primary gaze, and/or enophthalmos >2 mm, and/or 50% of the floor area involved in the fracture). The mean (SD) age of the patients was 31.5 (17.6) years (range, 8-73 years). The magnitude of agreement between the readers as measured by the intraclass correlation coefficient was 0.66 (95% CI, 0.46-0.82) for anterior to posterior length and 0.44 (95% CI, 0.22-0.69) for transverse width, indicating only a moderate degree of concordance.

Conclusions and Relevance  Although the literature has long held that a floor fracture seen radiographically to involve 50% of the orbital floor has a high likelihood of enophthalmia and should be repaired, this study shows how variable CT measurements of orbital floor fractures can be in a clinical setting, even in trained hands. We question the dependence on such a criterion and reemphasize the importance of making surgical decisions based on clinical findings rather than radiological interpretations.

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