Department of Trauma, University Hospital Zurich, Zurich, Switzerland.
PLoS One. 2018 Aug 23;13(8):e0201818. doi: 10.1371/journal.pone.0201818. eCollection 2018.
Several new definitions for categorizing the severely injured as the Berlin Definition have been developed. Here, severely injured patients are selected by additive physiological parameters and by the general Abbreviated Injury Scale (AIS)-based assessment. However, all definitions should conform to an AIS severity coding applied by an expert. We examined the dependence of individual coding on defining injury severity in general and in identifying polytrauma according to several definitions. A precise definition of polytrauma is important for quality management.
We investigated the interobserver reliability (IR) between several polytrauma definitions for identifying polytrauma using several cut-off levels (ISS ≥16, ≥18, ≥20, ≥25 points, and the Berlin Definition). One hundred and eighty-seven patients were included for analyzing IR of the polytrauma definitions. IR for polytrauma definitions was assessed by Cohen's kappa.
IR for identifying polytrauma according to the relevant definitions showed moderate agreement (<0.60) in the ISS cutoff categories (ISS ≥16, ≥18, and ≥20 points), while ISS ≥25 points just reached substantial agreement (0.62) and the Berlin Definition demonstrated a correlation of 0.77 which is nearly perfect agreement (>0.80).
Compared with the ISS-based definitions of polytrauma, the Berlin Definition proved less dependent on the individual rater. This underlines the need to redefine the selection of severely injured patients. Using the Berlin Definition for identifying polytrauma could improve the comparability of patient data across studies, in trauma center benchmarking, and in quality assurance.
为了对重伤患者进行分类，已经制定了几个新的定义，如柏林定义。这些定义通过附加的生理参数和广义的损伤严重程度评分（AIS）来选择重伤患者。然而，所有的定义都应该符合专家应用的 AIS 严重程度编码。我们研究了个体编码对一般损伤严重程度的定义和根据几种定义确定多发伤的依赖性。精确定义多发伤对于质量管理非常重要。
我们使用几种不同的创伤严重程度评分（ISS≥16、≥18、≥20、≥25 分和柏林定义）来调查几种多发伤定义识别多发伤的观察者间可靠性（IR）。对 187 例患者进行了分析，以评估不同的多发伤定义的 IR。IR 评估采用 Cohen 的 Kappa 系数。
根据相关定义，在 ISS 截断分类（ISS≥16、≥18 和≥20 分）中，识别多发伤的 IR 显示出中度一致性（<0.60），而 ISS≥25 分仅达到显著一致性（0.62），柏林定义显示出 0.77 的相关性，几乎是完美的一致性（>0.80）。
与基于 ISS 的多发伤定义相比，柏林定义对个体评分者的依赖性较小。这强调了需要重新定义重伤患者的选择。使用柏林定义识别多发伤可以提高研究之间、创伤中心基准测试和质量保证中患者数据的可比性。
