Comparison of clinician injury severity ratings with Abbreviated Injury Scale designations for thoracic injuries

The utility of the Abbreviated Injury Scale (AIS) for injury benchmarking and epidemiologic research depends on accurate injury severity designations. The objective of this study was to assess whether aggregated independent clinician assessments of injury severity differ from the official consensus-based AIS severity designations, focusing on common thoracic injuries.

Twenty-one thoracic injuries were selected, including rib fractures, sternal fractures, pneumothorax, and hemothorax. Radiographic images from patients with these injuries were obtained from the Crash Injury Research and Engineering Network (CIREN) database for 2017-2023. Clinicians were recruited to participate in an anonymous survey and independently rated each injury across four domains: threat to life, time to recovery, long-term morbidity, and overall injury severity. Overall severity ratings were recorded on an ordinal scale (1-6) anchored to AIS severity levels for injuries in other body regions. Agreement between aggregated clinician ratings and official AIS consensus severity designations was evaluated using ordinal regression.

There were 18 physicians who completed the survey, most of whom were trauma surgeons practicing at Level I trauma centers. Overall severity ratings exactly matched the AIS designation in 43% of responses, and 89% were within one severity level. Greater years of clinical practice and training in trauma surgery or emergency medicine were associated with higher agreement with AIS designations. Clinician-assigned overall severity ratings tended to be lower than AIS designations for pneumothorax and hemothorax at higher severity levels. Among the surveyed domains, perceived threat to life contributed most strongly to overall severity ratings.

Aggregated clinician assessments of injury severity generally aligned with AIS severity levels but frequently rated certain thoracic injuries as less severe at higher AIS levels. These findings suggest that clinician perceptions of severity may differ from consensus-based AIS designations, particularly for pneumothorax and hemothorax.