Format

Send to

Choose Destination
Foot Ankle Int. 2018 Sep;39(9):1056-1061. doi: 10.1177/1071100718778022. Epub 2018 Jun 4.

Vancouver Foot and Ankle WNS (Wound, Nerve, and Systemic) Classification System for Foot and Ankle Orthopedic Surgery.

Author information

1
1 Department of Orthopaedics, University of British Columbia, St. Paul's Hospital, Partner, Footbridge Centre for Integrated Foot and Ankle Care.
2
2 Rosalind Franklin University of Medicine, Chicago Medical School, Chicago, IL, USA.
3
3 Mayfair Radiology, Department of Radiology, University of Calgary, Calgary, AB, Canada.
4
4 Orthopaedic Foot and Ankle Surgeon, University Health Network, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada.
5
5 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
6
6 Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
7
7 James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, NC, USA.

Abstract

BACKGROUND:

Adverse events require consistent recording to determine the effect of alternate treatments. This study was undertaken to evaluate the Vancouver Foot and Ankle WNS complication scale to capture complications (W: wound, N: nerve, S: systemic) to assist in outcome recording.

METHODS:

Interrater reliability was tested in 2 settings: (1) between 2 blinded clinicians in a live clinical setting and (2) between 8 orthopedic surgeons using case vignettes based on a retrospective analysis of 500 foot and ankle procedures performed at the Toronto Western Hospital, Department of Orthopaedics. The intrarater reliability of the WNS scale was tested in a single rater using the case vignettes. Inter- and intrarater reliability were assessed using the Fleiss and Cohen weighted kappa ( k), respectively and 95% confidence intervals (CIs). There was adequate power over 0.8.

RESULTS:

In the live clinical setting, the Cohen weighted k (95% CI) values for the W (0.935 [0.862, 1.01]), N (0.914 [0.752, 1.08]), and S (1 [1, 1]) parameters, indicating a near perfect level of agreement between raters. In the broader community of professional foot and ankle surgeons, the Fleiss k values (95% CI) had moderate agreement for the W (0.712 [0.688, 0.735]), N (0.775 [0.738, 0.811]), and high agreement for S (0.834 [0.802, 0.866]) parameters based on case vignettes. However, the Fleiss k values continued to indicate moderate to strong agreement between raters for all parameters.

CONCLUSIONS:

The WNS scale provided a standardized method of measuring foot and ankle surgical complications. There was at least moderate-strong interrater agreement for all parameters measured on case vignettes and excellent concordance in the live setting.

LEVEL OF EVIDENCE:

Level III, comparative series.

KEYWORDS:

classification system; foot and ankle surgery; foot and ankle surgical complications; surgical complications

PMID:
29864377
DOI:
10.1177/1071100718778022
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center