Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Francie van Zijl Avenue, Tygerberg, Cape Town, 7505, South Africa.
Division of Urology, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
World J Urol. 2018 Mar;36(3):489-496. doi: 10.1007/s00345-017-2166-6. Epub 2018 Jan 2.
Although many radiologists invoke the surgical classification of renal injury proposed by the American Association for Surgery in Trauma (AAST), there has been only limited work on the role of the AAST system as an imaging stratification. The aim was to determine the inter-rater reliability (IRR) amongst radiologists and urologists using the AAST system.
A 1-year retrospective study of consecutive patients with computed tomography (CT) evidence of renal trauma managed at a Level 1 trauma center. Three radiologists and three urologists independently stratified the presentation CT findings according to the AAST renal trauma classification. Agreement between independent raters and mutually exclusive groups was determined utilizing weighted kappa coefficients.
One hundred and one patients were included. Individual inter-observer agreements ranged from 54/101 (53.4%) to 62/101 (61.4%), with corresponding weighted kappa values from 0.61 to 0.69, constituting substantial agreement. Urologists achieved intra-disciplinary agreement in 49 cases (48.5%) and radiologists in 36 cases (35.6%). Six-reader agreement was achieved in 24 cases (23.7%). The AAST grade I injuries had the highest level of agreement, overall.
The finding of substantial IRR amongst radiologists and urologists utilizing the AAST system supports continued use of the broad parameters of the AAST system, with some modification in specific categories with lower agreement.
尽管许多放射科医生援引美国外科创伤协会（AAST）提出的外科肾损伤分类，但对 AAST 系统作为影像学分层的作用的研究有限。目的是确定放射科医生和泌尿科医生使用 AAST 系统的组内一致性（IRR）。
对在一级创伤中心接受 CT 证实肾损伤的连续患者进行了为期 1 年的回顾性研究。三位放射科医生和三位泌尿科医生独立根据 AAST 肾损伤分类对 CT 表现进行分层。利用加权 kappa 系数确定独立评分者之间以及相互排斥组之间的一致性。
共纳入 101 例患者。个体观察者之间的一致性范围为 54/101（53.4%）至 62/101（61.4%），对应的加权 kappa 值为 0.61 至 0.69，构成高度一致。泌尿科医生在 49 例（48.5%）中达成了内部一致性，放射科医生在 36 例（35.6%）中达成了内部一致性。六位读者达成了 24 例（23.7%）的一致。总体而言，AAST Ⅰ级损伤的一致性最高。
放射科医生和泌尿科医生使用 AAST 系统的结果显示了实质性的组内一致性，支持继续使用 AAST 系统的广泛参数，对某些一致性较低的特定类别进行一些修改。
