{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:14:01Z","timestamp":1777612441894,"version":"3.51.4"},"reference-count":9,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2018,6,4]],"date-time":"2018-06-04T00:00:00Z","timestamp":1528070400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2018,9]]},"abstract":"\n Background:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n Level III, comparative series.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/1071100718778022","type":"journal-article","created":{"date-parts":[[2018,6,4]],"date-time":"2018-06-04T19:23:28Z","timestamp":1528140208000},"page":"1056-1061","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Vancouver Foot and Ankle WNS (Wound, Nerve, and Systemic) Classification System for Foot and Ankle Orthopedic Surgery"],"prefix":"10.1177","volume":"39","author":[{"given":"Andrea","family":"Veljkovic","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, University of British Columbia, St. Paul\u2019s Hospital, Partner, Footbridge Centre for Integrated Foot and Ankle Care"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murray","family":"Penner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of British Columbia, St. Paul\u2019s Hospital, Partner, Footbridge Centre for Integrated Foot and Ankle Care"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Wing","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of British Columbia, St. Paul\u2019s Hospital, Partner, Footbridge Centre for Integrated Foot and Ankle Care"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaniza Zahra","family":"Abbas","sequence":"additional","affiliation":[{"name":"Rosalind Franklin University of Medicine, Chicago Medical School, Chicago, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Salat","sequence":"additional","affiliation":[{"name":"Mayfair Radiology, Department of Radiology, University of Calgary, Calgary, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johnny","family":"Lau","sequence":"additional","affiliation":[{"name":"Orthopaedic Foot and Ankle Surgeon, University Health Network, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John E.","family":"Femino","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phinit","family":"Phisitkul","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annunziato","family":"Amendola","sequence":"additional","affiliation":[{"name":"James R. Urbaniak, MD, Sports Sciences Institute, Duke University, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alastair","family":"Younger","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of British Columbia, St. Paul\u2019s Hospital, Partner, Footbridge Centre for Integrated Foot and Ankle Care"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,6,4]]},"reference":[{"key":"bibr1-1071100718778022","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181b13ca2"},{"issue":"5","key":"bibr2-1071100718778022","first-page":"518","volume":"111","author":"Clavien PA","year":"1992","journal-title":"Surgery"},{"key":"bibr3-1071100718778022","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"issue":"2","key":"bibr4-1071100718778022","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/j.1399-0012.1998.tb01076.x","volume":"12","author":"Hunt CM","year":"1998","journal-title":"Clin Transplant"},{"key":"bibr5-1071100718778022","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2012.031"},{"key":"bibr6-1071100718778022","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715609719"},{"key":"bibr7-1071100718778022","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24817"},{"key":"bibr8-1071100718778022","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-012-2343-2"},{"key":"bibr9-1071100718778022","doi-asserted-by":"publisher","DOI":"10.1186\/1754-9493-5-30"}],"container-title":["Foot & Ankle International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1071100718778022","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1071100718778022","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1071100718778022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T21:22:57Z","timestamp":1777411377000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1071100718778022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,4]]},"references-count":9,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1177\/1071100718778022"],"URL":"https:\/\/doi.org\/10.1177\/1071100718778022","relation":{},"ISSN":["1071-1007","1944-7876"],"issn-type":[{"value":"1071-1007","type":"print"},{"value":"1944-7876","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,4]]}}}