{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:22:10Z","timestamp":1777522930740,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2018,2,22]],"date-time":"2018-02-22T00:00:00Z","timestamp":1519257600000},"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":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Oronasal fistula is an important complication of cleft palate repair that is frequently used to evaluate surgical quality, yet reliability of fistula classification has never been examined. The objective of this study was to determine the reliability of oronasal fistula classification both within individual surgeons and between multiple surgeons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Using intraoral photographs of children with repaired cleft palate, surgeons rated the location of palatal fistulae using the Pittsburgh Fistula Classification System. Intrarater and interrater reliability scores were calculated for each region of the palate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>Eight cleft surgeons rated photographs obtained from 29 children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Within individual surgeons reliability for each region of the Pittsburgh classification ranged from moderate to almost perfect (\u03ba = .60-.96). By contrast, reliability between surgeons was lower, ranging from fair to substantial (\u03ba = .23-.70). Between-surgeon reliability was lowest for the junction of the soft and hard palates (\u03ba = .23). Within-surgeon and between-surgeon reliability were almost perfect for the more general classification of fistula in the secondary palate (\u03ba = .95 and \u03ba = .83, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This is the first reliability study of fistula classification. We show that the Pittsburgh Fistula Classification System is reliable when used by an individual surgeon, but less reliable when used among multiple surgeons. Comparisons of fistula occurrence among surgeons may be subject to less bias if they use the more general classification of \u201cpresence or absence of fistula of the secondary palate\u201d rather than the Pittsburgh Fistula Classification System.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1597\/16-186","type":"journal-article","created":{"date-parts":[[2016,12,29]],"date-time":"2016-12-29T14:01:18Z","timestamp":1483020078000},"page":"871-875","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["Reliability of Oronasal Fistula Classification"],"prefix":"10.1177","volume":"55","author":[{"given":"Thomas J.","family":"Sitzman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander C.","family":"Allori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damir B.","family":"Matic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen P.","family":"Beals","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Fisher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas D.","family":"Samson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey R.","family":"Marcus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond W.","family":"Tse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"The Americleft Task Force Surgeon Subgroup","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,2,22]]},"reference":[{"key":"bibr1-16-186","author":"Allori A.C.","journal-title":"Cleft Palate Craniofac J"},{"key":"bibr2-16-186","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001324"},{"key":"bibr3-16-186","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.20281"},{"key":"bibr4-16-186","doi-asserted-by":"publisher","DOI":"10.4103\/2231-0746.175776"},{"key":"bibr5-16-186","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2011.02.024"},{"key":"bibr6-16-186","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000548"},{"key":"bibr7-16-186","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"bibr8-16-186","doi-asserted-by":"publisher","DOI":"10.1597\/15-123"},{"key":"bibr9-16-186","first-page":"525","volume-title":"Comprehensive Cleft Care","author":"Losee J.E.","year":"2009"},{"key":"bibr10-16-186","doi-asserted-by":"publisher","DOI":"10.1597\/14-193"},{"key":"bibr11-16-186","volume-title":"Epidemiolgy\u2014An Introduction","author":"Rothman K.J.","year":"2012"},{"key":"bibr12-16-186","doi-asserted-by":"publisher","DOI":"10.1597\/14-206"},{"key":"bibr13-16-186","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/85.3.257"},{"key":"bibr14-16-186","doi-asserted-by":"publisher","DOI":"10.1597\/06-204.1"},{"key":"bibr15-16-186","doi-asserted-by":"publisher","DOI":"10.1597\/15-206"},{"key":"bibr16-16-186","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(88)90031-5"},{"key":"bibr17-16-186","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0b013e31824dbd68"},{"key":"bibr18-16-186","unstructured":"U.S. Department of Health and Human Services. Protection of human subjects. 45 CFR \u00a746. Revised January 15, 2009. Effective July 14, 2009. Available at https:\/\/www.hhs.gov\/ohrp\/sites\/default\/files\/ohrp\/policy\/ohrpregulations.pdf. Accessed December 28, 2016."},{"key":"bibr19-16-186","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e3181d60763"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1597\/16-186","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1597\/16-186","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1597\/16-186","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T16:19:05Z","timestamp":1777393145000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1597\/16-186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,22]]},"references-count":19,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2018,7]]}},"alternative-id":["10.1597\/16-186"],"URL":"https:\/\/doi.org\/10.1597\/16-186","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,22]]}}}