简略损伤量表：在创伤机构中作为损伤严重程度汇总的依据是否不可靠？

Abbreviated Injury Scale: not a reliable basis for summation of injury severity in trauma facilities?

机构信息

Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway.

出版信息

Injury. 2013 May;44(5):691-9. doi: 10.1016/j.injury.2012.06.032. Epub 2012 Jul 24.

DOI:10.1016/j.injury.2012.06.032

PMID:22831922

Abstract

BACKGROUND

Injury severity is most frequently classified using the Abbreviated Injury Scale (AIS) as a basis for the Injury Severity Score (ISS) and the New Injury Severity Score (NISS), which are used for assessment of overall injury severity in the multiply injured patient and in outcome prediction. European trauma registries recommended the AIS 2008 edition, but the levels of inter-rater agreement and reliability of ISS and NISS, associated with its use, have not been reported.

METHODS

Nineteen Norwegian AIS-certified trauma registry coders were invited to score 50 real, anonymised patient medical records using AIS 2008. Rater agreements for ISS and NISS were analysed using Bland-Altman plots with 95% limits of agreement (LoA). A clinically acceptable LoA range was set at ± 9 units. Reliability was analysed using a two-way mixed model intraclass correlation coefficient (ICC) statistics with corresponding 95% confidence intervals (CI) and hierarchical agglomerative clustering.

RESULTS

Ten coders submitted their coding results. Of their AIS codes, 2189 (61.5%) agreed with a reference standard, 1187 (31.1%) real injuries were missed, and 392 non-existing injuries were recorded. All LoAs were wider than the predefined, clinically acceptable limit of ± 9, for both ISS and NISS. The joint ICC (range) between each rater and the reference standard was 0.51 (0.29,0.86) for ISS and 0.51 (0.27,0.78) for NISS. The joint ICC (range) for inter-rater reliability was 0.49 (0.19,0.85) for ISS and 0.49 (0.16,0.82) for NISS. Univariate linear regression analyses indicated a significant relationship between the number of correctly AIS-coded injuries and total number of cases coded during the rater's career, but no significant relationship between the rater-against-reference ISS and NISS ICC values and total number of cases coded during the rater's career.

CONCLUSIONS

Based on AIS 2008, ISS and NISS were not reliable for summarising anatomic injury severity in this study. This result indicates a limitation in their use as benchmarking tools for trauma system performance.

摘要

背景

伤害严重程度通常使用简明损伤定级（Abbreviated Injury Scale，AIS）作为伤害严重程度评分（Injury Severity Score，ISS）和新伤害严重程度评分（New Injury Severity Score，NISS）的基础进行分类，这些评分用于评估多发伤患者的整体伤害严重程度和预测结果。欧洲创伤登记处建议使用 AIS 2008 版，但尚未报告其使用相关的 ISS 和 NISS 的评分者间一致性和可靠性水平。

方法

19 名挪威 AIS 认证的创伤登记处编码员被邀请使用 AIS 2008 对 50 份真实的匿名患者病历进行评分。使用 Bland-Altman 图和 95%一致性界限（Limits of Agreement，LoA）分析 ISS 和 NISS 的评分者间一致性。将临床可接受的 LoA 范围设定为±9 个单位。使用双向混合模型组内相关系数（Intraclass Correlation Coefficient，ICC）统计分析和相应的 95%置信区间（Confidence Interval，CI）以及层次凝聚聚类分析来评估可靠性。

结果

10 名编码员提交了他们的编码结果。他们的 AIS 编码中，2189 个（61.5%）与参考标准一致，1187 个（31.1%）真实损伤被遗漏，392 个非存在的损伤被记录。对于 ISS 和 NISS，所有的 LoA 都大于预定义的临床可接受界限±9。对于每个编码员与参考标准之间的联合 ICC（范围），ISS 为 0.51（0.29，0.86），NISS 为 0.51（0.27，0.78）。对于评分者间可靠性的联合 ICC（范围），ISS 为 0.49（0.19，0.85），NISS 为 0.49（0.16，0.82）。单变量线性回归分析表明，正确 AIS 编码的损伤数量与编码员职业生涯期间编码的总病例数之间存在显著关系，但编码员与参考标准的 ISS 和 NISS ICC 值与编码员职业生涯期间编码的总病例数之间不存在显著关系。