Injury Severity Scoring in the Resuscitation Room-Is Preliminary Injury Severity Score Accurate?

Area of Science:

• Trauma Care
• Emergency Medicine
• Clinical Assessment

Background:

• Injury Severity Score (ISS) is crucial for trauma patient classification and trauma center performance evaluation.
• Accurate ISS calculation is fundamental for reliable injury severity assessment.
• This study evaluated the accuracy of preliminary ISS in the resuscitation room.

Purpose of the Study:

• To analyze the accuracy of preliminary Injury Severity Score (ISS) in trauma patients during resuscitation.
• To compare preliminary ISS assessed by clinicians with definitive ISS determined by certified coders.
• To assess interrater agreement between preliminary and definitive ISS.

Main Methods:

• Retrospective analysis of 3623 trauma patients from January 2019 to May 2024.
• Comparison of preliminary ISS (non-certified clinicians) with definitive ISS (certified AIS coders).
• Interrater agreement assessed using Cohen's Kappa and Bland-Altman plots.

Main Results:

• Moderate overall agreement (Cohen's Kappa = 0.51) between preliminary and definitive ISS.
• Lowest agreement observed in seriously injured patients (ISS 15-24), Kappa = 0.31.
• Bland-Altman plot indicated acceptable agreement, with a trend of underestimation in higher ISS values.

Conclusions:

• A moderate, acceptable agreement exists between preliminary and definitive ISS in trauma patients.
• Preliminary ISS may underestimate injury severity in critically injured patients.
• Preliminary ISS is a valuable tool, but findings necessitate cautious interpretation for severe trauma cases.