Interobserver Reliability of Pirani Clubfoot Severity Scoring between an Orthopedic Surgeon, a Resident Doctor, and a Nonmedical Counsellor at a Clubfoot Clinic.

Abstract

Ponseti method is the gold standard treatment for idiopathic congenital clubfoot. Pirani clubfoot severity score is a vital tool in assessing treatment of clubfoot. This study determines whether, after a short training in the Pirani scoring, a nonmedical personnel can be as accurate as a doctor in assessing the degree of deformity in clubfoot. This was a prospective observational study from January to September 2016. Pirani scoring of all children ≤6 months was done by the counsellor, an orthopedic resident, and a consultant separately. All the three members of the team were blinded of the other's score. The Pirani scoring of the consultant was taken as the most correct. The data were analyzed for interobserver reliability using the kappa statistic and point-by-point interobserver agreements. One hundred and fifteen clubfeet in 75 children (48 males and 27 females) with an average age of 96 days were included in the study. Differences between the means of scores for each severity component of the deformity including the sum of midfoot scores, hindfoot scores, and total foot scores were <0.1. There was fair-to-substantial interobserver reliability of all the subcomponents when scores from the three independent observers were analyzed. Our study successfully demonstrates that after a short training, Pirani score can be successfully used in assessing clubfoot severity by a nonmedical counsellor.