Inter-observers Level of Agreement in Cervical Vertebral Maturation Staging

The objective of this study was to determine the inter-observers level of agreement in interpreting cervical vertebral maturation (CVM) stages. This cross-sectional study was carried out at the Department of Orthodontics, Khyber College of Dentistry. The patient’s lateral cephalograms present in the Department were used. Sixty randomly selected cephalograms were digitized by using Nikon camera L-830. The images were cropped to visualize only cervical vertebrae. Subsequently, the images were loaded into PowerPoint to prepare a presentation for rating. A PowerPoint presentation consisted of a detailed description of the CVM method along with the instructions how to rate, separately all stages of skeletal maturity. Two raters assessed the CVM stages according to Baccetti et al. The kappa statistics was used to assess inter-assessor agreement in assigning CVM scores. Out of 60 sample size twenty-eight (46.7%) were males and 32(53.3) were females. Frequencies of agreement between two raters for CVM1, CVM2, CVM3, CVM4, CVM5, and CVM6 were 100%, 100%, 50%, 100%, 46.1%, and 60% respectively. Frequencies of disagreement for CVM3 were 50%, CVM5 was 53.9% and CVM6 was 40%. The overall level agreement between two examiners was 49.1% with Kappa value of 0.491(moderate agreement) with statistical significance (P=0.000). The Spearman's rho correlation co-efficient was 0.886 for two observers. Within the limit of this study, it is recommended that CVM should be augmented with other biologic maturity indicators while assessing growth status.