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

Abstract

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.

Those who speak survive: the value of the verbal component of GCS in trauma

“…The patients who survived had significantly lower median (IQR) heart rate, 85 (77-94) vs 97 (80-100) beats/min, p = 0.04; and lower ISS, 4 (4-9) vs 16 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), p < 0.001, compared with those who died. Patients who survived had significantly higher median (IQR) GCS: 15 (15-15) vs 10…”

“…Also, the ISS is an anatomical scoring which neglects the physiological differences and different interactions that patients express in response to trauma [18]. In addition, low inter-observer agreement of ISS has been reported [19]. Finally, ISS requires training and time to calculate [20].…”

Those who speak survive: The value of the verbal component of GCS in trauma

“…Also, the ISS is an anatomical scoring which neglects the physiological differences and different interactions that patients express in response to trauma [19]. In addition, low inter-observer agreement of ISS has been reported [20]. Finally, ISS requires training and time to calculate [21].…”

Anatomical Injury Clusters in Polytrauma Patients

“…However, here starts the inter-observer bias in the evaluation of polytrauma patients. Several studies have been on this topic published, pointing on a very heterogeneous judgement even by the experts in this field [18][19][20]. The point when a thoracic injury turns into a spinal injury, for example, is not that clear.…”

“…The main limitation in this study might root in the AIS scoring, hence not automatically/digitally performed, but by different investigators. This inter-observer bias might lead to a background noise in the precision of this analysis [18][19][20].…”