Assessment of polytraumatized patients according to the Berlin Definition: Does the addition of physiological data really improve interobserver reliability?

Pothmann, Carina; S, Baumann; Jensen, Kai Oliver; Mica, Ladislav; Osterhoff, Georg; Simmen, Hans‐Peter; Sprengel, Kai

doi:10.1371/journal.pone.0201818

Cited by 16 publications

(13 citation statements)

References 24 publications

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“…Furthermore, the focus was mainly on the different cut-off values of the various polytrauma definitions, therefore only indirectly assessing the interrater variability of the current injury severity coding systems. Discussing the results, Pothmann et al advocated the comparatively greater interobserver agreement on polytrauma identification based on MAIS, which partly confirms the respective results on pediatric trauma from Brown et al [ 39 , 40 ]. This could also imply the influence of the injured anatomical regions on the measured interobserver variability.…”

Section: Discussionsupporting

confidence: 55%

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Interobserver variability of injury severity assessment in polytrauma patients: does the anatomical region play a role?

et al. 2021

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Background The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are widely used to assess trauma patients. In this study, the interobserver variability of the injury severity assessment for severely injured patients was analyzed based on different injured anatomical regions, and the various demographic backgrounds of the observers. Methods A standardized questionnaire was presented to surgical experts and participants of clinical polytrauma courses. It contained medical information and initial X-rays/CT-scans of 10 cases of severely injured patients. Participants estimated the severity of each injury based on the AIS. Interobserver variability for the AIS, ISS, and New Injury Severity Score (NISS) was calculated by employing the statistical method of Krippendorff's α coefficient. Results Overall, 54 participants were included. The major contributing medical specialties were orthopedic trauma surgery (N = 36, 67%) and general surgery (N = 13, 24%). The measured interobserver variability in the assessment of the overall injury severity was high (α ISS: 0.33 / α NISS: 0.23). Moreover, there were differences in the interobserver variability of the maximum AIS (MAIS) depending on the anatomical region: αhead and neck: 0.06, αthorax: 0.45, αabdomen: 0.27 and αextremities: 0.55. Conclusions Interobserver agreement concerning injury severity assessment appears to be low among clinicians. We also noted marked differences in variability according to injury anatomy. The study shows that the assessment of injury severity is also highly variable between experts in the field. This implies the need for appropriate education to improve the accuracy of trauma evaluation in the respective trauma registries.

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Section: Discussionsupporting

confidence: 55%

“…For the purposes of the Neale et al study, six specially educated coders assessed 120 injury cases. The high interobserver variability of the AIS-based definitions of a polytraumatized patient was confirmed by a recent study by Pothmann et al [ 39 ]. In their study, two observer groups coded a total of 187 polytrauma cases.…”

Section: Discussionmentioning

confidence: 64%

Interobserver variability of injury severity assessment in polytrauma patients: does the anatomical region play a role?

et al. 2021

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“…Regarding the outcome of patients in the Our study showed (18.4%) mortality rate ( Figure 1) which higher than Pfeifer et al, in which mortality rate in polytrauma patients (6.4%) and also higher than Mica et al, in which mortality rate was (9.6%) and in Dijkink et al study mortality rate (10%). 1,[16][17][18] Higher mortality rate of our study maybe due to we compare with specialized trauma center which highly prepared and about ICU admission, our study showed (44.7%) ( Figure 1) which agree with Dijkink et al, in which ICU admission percentage (47.3%). 18 The study demonstrated a need to improve overall ATLS compliance at our institution.…”

Section: Discussionsupporting

confidence: 87%

Assessment of management of polytrauma patients in the emergency department in Suez Canal University hospital

et al. 2019

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Egypt is higher several times due to under-reporting and misclassification. 1 The Egyptian Ministry of Health estimated that 24,222 deaths, 127,216 hospitalizations and 847,912 disability-adjusted life years occurred due to ABSTRACT Background: Trauma is a serious global health problem, it is the fifth leading cause of significant disability and is still the most frequent cause of death in the first four decades of life, accounting for approximately one in 10 deaths worldwide. Methods: This study is cross sectional prospective study was conducted to evaluate assessment of management of patients according to the advanced trauma life support guideline in Emergency Department at Suez Canal University Hospital. All patients (n=103) were subjected to baseline assessment by history, clinical examination and investigations. The patients were followed up and recorded till the full assessment was done and the decision was made and the fate of the patient was recorded. Results: The majority of the studied patient had motor car crash (55.30%), while motor cycle crash was the second mechanism of trauma (21.40%), run over was the third mechanism (14.60%). Airway management was done (95.1%), cervical spine kept immobilized only in (71.8%). Blood pressure was measured in (97.1%) and 2ry survey assessment, head to toe examination (78.6%), while AMPLE history was taken in minority of cases percentage (33%). Finally majority of patients was admitted in ICU (44.70%), followed by 18.40% of the studied patient died and less than (2%) discharged from the ER. Conclusions: ATLS protocols provide a common framework and organized approach during polytrauma patient's management. Also, it has been shown to improve outcomes so we should enhance its application in our hospital.

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“…Especially, elderly patients, mainly > 75 years of age show a peak in mortality which is seen around day 6 after the initial trauma [19]. The New Berlin Definition uses an age > 70 years as physiological condition for polytraumatized patients with an increased mortality rate [12][13][14][15]. This cut-off of > 70 years was chosen due to a higher mortality rate in this age group [12].…”

Section: Discussionmentioning

confidence: 99%

“…A well-known definition of polytrauma is the New Berlin Definition that adds at least one of five standardized physiological conditions to the definition of ISS ≥ 16 and at least two different affected body regions with an AIS ≥ 3 [12]. The New Berlin Definition has been shown to be feasible and applicable for polytrauma patients [12][13][14][15]. Rau et al [13] showed that polytrauma patients identified according to the New Berlin Definition had significantly higher ISS scores and significantly higher mortality rates.…”

Section: Introductionmentioning

confidence: 99%

Age and traumatic brain injury as prognostic factors for late-phase mortality in patients defined as polytrauma according to the New Berlin Definition: experiences from a level I trauma center

Weihs

Heel

Ducreux

et al. 2020

Arch Orthop Trauma Surg

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Background The rationale of this study was to identify independent prognostic factors influencing the late-phase survival of polytraumatized patients defined according to the New Berlin Definition. Methods Retrospective data analysis on 173 consecutively polytraumatized patients treated at a level I trauma center between January 2012 and December 2015. Patients were classified into two groups: severely injured patients (ISS > 16) and polytraumatized patients (patients who met the diagnostic criteria for the New Berlin Definition). Results Polytraumatized patients showed significantly lower late-phase and overall survival rates. The presence of traumatic brain injury (TBI) and age > 55 years had a significant influence on the late-phase survival in polytraumatized patients but not in severely injured patients. Despite the percentage of severe TBI being nearly identical in both groups, severe TBI was identified as main cause of death in polytraumatized patients. Furthermore, severe TBI remains the main cause of death in polytraumatized patients > 55 years of age, whereas younger polytraumatized patients (< 55 years of age) tend to die more often due to the acute trauma. Conclusion Our results suggest that age beyond 55 years and concomitant (severe) TBI remain as most important influencing risk factor for the late-phase survival of polytraumatized patients but not in severely injured patients. Level of evidence Prognostic study, level III.

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Assessment of polytraumatized patients according to the Berlin Definition: Does the addition of physiological data really improve interobserver reliability?

Cited by 16 publications

References 24 publications

Interobserver variability of injury severity assessment in polytrauma patients: does the anatomical region play a role?

Interobserver variability of injury severity assessment in polytrauma patients: does the anatomical region play a role?

Assessment of management of polytrauma patients in the emergency department in Suez Canal University hospital

Age and traumatic brain injury as prognostic factors for late-phase mortality in patients defined as polytrauma according to the New Berlin Definition: experiences from a level I trauma center

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