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Interobserver Variability in Injury Severity Scoring After Combat Trauma: Different Perspectives, Different Values?

Iain M Smith, David N Naumann, Paul Guyver

    Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals
    |July 1, 2015
    PubMed
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    Surgeons and trauma nurse coordinators show discrepancies in assigning Abbreviated Injury Scale (AIS(M)) scores. Improved accuracy in trauma burden assessment may result from collaborative scoring processes.

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    Area of Science:

    • Trauma care research
    • Medical informatics
    • Military medicine

    Background:

    • Anatomic injury burden measures are crucial for trauma care studies.
    • The military Abbreviated Injury Scale (AIS(M)) is vital for scoring injuries in deployed settings.
    • Current scoring relies on retrospective chart review.

    Purpose of the Study:

    • To compare injury severity scores assigned by surgeons with those recorded in the UK Joint Theatre Trauma Registry (JTTR).
    • To assess concordance between surgeons and trauma nurse coordinators in assigning trauma injury severity.
    • To evaluate the accuracy of retrospective chart review for trauma burden estimation.

    Main Methods:

    • Compares AIS(M) scores assigned by surgeons to trauma casualties with JTTR data.
    • Analyzes Injury Severity Score (ISS) and New Injury Severity Score (NISS) between datasets.
    • Utilizes data from a deployed Role 3 hospital between September and October 2012.

    Main Results:

    • Low agreement (19%) in the number of recorded injuries between surgeons and JTTR.
    • Moderate agreement (66%) for maximum AIS(M) scores, but lower for ISS (34%) and NISS (28%).
    • No statistically significant difference in the distribution of ISS and NISS between surgeons and JTTR.

    Conclusions:

    • Significant discrepancies exist in AIS(M) scoring between direct care surgeons and retrospective chart review by nurse coordinators.
    • Retrospective chart review may lead to inaccuracies in trauma burden assessment.
    • Active collaboration between clinical teams and data recorders can enhance scoring accuracy.