Reliability of injury grading systems for patients with blunt splenic trauma

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• 作者：D.C. Olthof ; C.H. van der Vlies ; M.J. Scheerder ; R.J. de Haan ; L.F.M. Beenen ; J.C. Goslings ; O.M. van Delden
• 关键词：Blunt abdominal trauma ; Splenic injury ; Interobserver reliability ; Intraobserver reliability ; Injury grading system(s)
• 刊名：Injury
• 出版年：January, 2014
• 年：2014
• 卷：45
• 期：1
• 页码：146-150
• 全文大小：351 K

文摘

Objectives

The most widely used grading system for blunt splenic injury is the American Association for the Surgery of Trauma (AAST) organ injury scale. In 2007 a new grading system was developed. This 鈥楤altimore CT grading system鈥?is superior to the AAST classification system in predicting the need for angiography and embolization or surgery. The objective of this study was to assess inter- and intraobserver reliability between radiologists in classifying splenic injury according to both grading systems.

Methods

CT scans of 83 patients with blunt splenic injury admitted between 1998 and 2008 to an academic Level 1 trauma centre were retrospectively reviewed. Inter and intrarater reliability were expressed in Cohen's or weighted Kappa values.

Results

Overall weighted interobserver Kappa coefficients for the AAST and 鈥楤altimore CT grading system鈥?were respectively substantial (kappa = 0.80) and almost perfect (kappa = 0.85). Average weighted intraobserver Kappa's values were in the 鈥榓lmost perfect鈥?range (AAST: kappa = 0.91, 鈥楤altimore CT grading system鈥? kappa = 0.81).

Conclusion

The present study shows that overall the inter- and intraobserver reliability for grading splenic injury according to the AAST grading system and 鈥楤altimore CT grading system鈥?are equally high. Because of the integration of vascular injury, the 鈥楤altimore CT grading system鈥?supports clinical decision making. We therefore recommend use of this system in the classification of splenic injury.