Phan Q-B, Mourey E, Estivalet L, Delattre B, Bardet F, Chevallier O, Louis D, Aho L S, Loffroy R, Cormier L
Urologie, CHU François-Mitterand, Dijon, France.
Radiologie, CHU François-Mitterand, Dijon, France.
Prog Urol. 2018 Jan;28(1):12-17. doi: 10.1016/j.purol.2017.09.013. Epub 2017 Nov 7.
The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) is the most used classification for renal trauma. It determines the radiologic monitoring, only recommended for high-grade injuries. The aim of this study was to assess the subjectivity of AAST scaling and its impact on short-term follow-up.
We retrospectively reviewed all patients with blunt renal injuries admitted at a university hospital between 2010 and 2015. Computed Tomography (CT) scan were analyzed and injuries graded according to AAST OIS independently by a senior radiologist, a senior urologist who was blind to clinical data and a resident urologist. Grading disagreements were analyzed collegially to obtain a final rating. The agreement of AAST scaling was evaluated through the Cohen's Kappa coefficient.
Ninety-seven patients had 101 renal injuries: low grade in 58.4% (11.9% grade I, 17.8% grade II, 28.7% grade III) and high grade in 41.6% of cases (23.6% grade IV and 17.8% grade V). The agreement was fair with Kappa coefficient at 0.36. The agreement was moderate in severity sub-division analysis (low or high grade): Kappa coefficient at 0.59. There was a disagreement in 49.5% between the senior urologist's and the senior radiologist's ratings. Those differences brought to a severity group change and radiologic follow-up modification in 34% (n=17).
AAST OIS for renal trauma suffers from subjectivity but is improved by severity sub-group analysis. This subjectivity influences the radiologic follow-up but could be reduced by collegiate rating.
美国创伤外科学会（AAST）器官损伤分级（OIS）是肾创伤最常用的分类方法。它决定了放射学监测，仅推荐用于高级别损伤。本研究的目的是评估AAST分级的主观性及其对短期随访的影响。
我们回顾性分析了2010年至2015年间在一家大学医院收治的所有钝性肾损伤患者。由一位资深放射科医生、一位对临床数据不知情的资深泌尿外科医生和一位泌尿外科住院医生独立根据AAST OIS对计算机断层扫描（CT）进行分析并对损伤进行分级。对分级分歧进行共同分析以获得最终评级。通过科恩卡方系数评估AAST分级的一致性。
97例患者有101处肾损伤：低级别损伤占58.4%（I级11.9%，II级17.8%，III级28.7%），高级别损伤占41.6%（IV级23.6%，V级17.8%）。一致性一般，卡方系数为0.36。在严重程度细分分析（低级别或高级别）中一致性为中等：卡方系数为0.59。资深泌尿外科医生和资深放射科医生的评级之间有49.5%存在分歧。这些差异导致34%（n = 17）的患者严重程度组改变和放射学随访调整。
肾创伤的AAST OIS存在主观性，但通过严重程度亚组分析可得到改善。这种主观性影响放射学随访，但可通过共同评级降低。
4级。
