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Preventable death classification: interrater reliability and comparison with ISS-based survival probability estimates

J S Sampalis1, S Boukas, A Nikolis

  • 1Department of Surgery, Montreal General Hospital, Quebec, Canada.

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Summary

The Injury Severity Score (ISS) effectively predicts survival in severe trauma patients, matching expert committee assessments. This study supports the continued use of ISS for trauma severity classification.

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Area of Science:

  • Trauma Surgery
  • Clinical Outcomes Research
  • Injury Biomechanics

Background:

  • Accurate assessment of injury severity is crucial for predicting patient outcomes.
  • The Injury Severity Score (ISS) is a widely used metric, but its accuracy compared to expert clinical judgment requires further investigation.

Purpose of the Study:

  • To compare the accuracy of the Injury Severity Score (ISS) with expert clinician consensus in estimating injury-related threat to survival.
  • To evaluate the added benefit of a multidisciplinary committee in classifying trauma patient survivability.

Main Methods:

  • Retrospective review of 116 severe injury cases (73 fatalities, 43 survivors).
  • Classification of cases by a nine-clinician committee and by ISS values into survivable, potentially survivable, and nonsurvivable categories.
  • Statistical analysis using intraclass correlation coefficient and weighted kappa to assess interrater reliability and agreement.

Main Results:

  • Poor interrater reliability was found among the nine clinicians (intraclass correlation coefficient = 0.43).
  • The ISS-based classification demonstrated high agreement with the final committee classification (weighted kappa = 0.71).
  • Agreement decreased for fall-related injuries and with a higher number of injuries.

Conclusions:

  • The Injury Severity Score (ISS) provides a reliable and effective method for classifying injury severity and predicting survival.
  • Utilizing a committee of experts does not offer additional benefits over ISS-based survival probability estimations.
  • The findings support the continued clinical application and reliance on the ISS for trauma severity assessment.