Sammoud Skander, Bastide Sophie, Ghelfi Julien, Arvieux Catherine, Monnin-Bares Valérie, Beregi Jean-Paul, Tidadini Fatah, Frandon Julien
Department of Medical Imaging, MAGINE UR UM 103, Nîmes University Hospital, Montpellier University, 30029, Nîmes, France.
« HEVA », Lyon, France.
Radiol Med. 2025 Jun 3. doi: 10.1007/s11547-025-02021-y.
The spleen is frequently injured in blunt abdominal trauma, and proper management depends on accurate CT assessment using the AAST-OIS scoring system. However, the reproducibility of CT scoring in trauma patients remains uncertain.
To assess the reproducibility of AAST-OIS scoring for high-grade splenic injuries (grades 3, 4, and 5) without vascular anomalies on initial CT scans and to evaluate the clinical impact of misclassification, particularly in relation to hemorrhagic complications.
This study is an ancillary analysis of the SPLASH-randomized clinical trial, which involved 6 Level 1 trauma centers in France. Initial CT scans were scored by the trauma center's radiology team and then independently reviewed by two expert radiologists. Interobserver agreement as assessed between the trauma center radiologists and the expert reviewers, as well as between the two independent experts. The study also examined whether underestimation of injury severity influenced early clinical outcomes.
The agreement between trauma center radiologists and expert reviewers was moderate, with kappa coefficients of 0.493 using linear weighting and 0.511 using quadratic weighting, whereas inter-expert agreement was excellent (kappa: 0.905 linear, 0.917 quadratic). The primary source of discordance was the underestimation of parenchymal devascularization, which frequently led to misclassification of grade 4 injuries as grade 3. hile overall complications on Day 5 did not significantly differ between correctly classified and misclassified patients (p = 0.0593), patients whose injuries were underestimated (false negatives) had a threefold higher risk of hemorrhagic complications compared to the rest of the cohort (p = 0.0351).
This study highlights the moderate reproducibility of AAST-OIS scoring in emergency trauma settings, emphasizing the need for standardized evaluation protocols to improve diagnostic consistency. Given the higher risk of hemorrhagic complications in underestimated cases, increased awareness of parenchymal devascularization and improved radiological training are essential to optimizing patient outcomes. The integration of AI-based decision-support tools and structured reporting templates may enhance real-time injury classification and reduce observer variability.
脾脏在钝性腹部创伤中常受损伤，恰当的处理取决于使用美国创伤外科学会器官损伤分级（AAST-OIS）评分系统进行准确的CT评估。然而，创伤患者CT评分的可重复性仍不确定。
评估初次CT扫描时无血管异常的高级别脾损伤（3级、4级和5级）的AAST-OIS评分的可重复性，并评估错误分类的临床影响，尤其是与出血并发症相关的影响。
本研究是对SPLASH随机临床试验的辅助分析，该试验涉及法国的6个一级创伤中心。初次CT扫描由创伤中心的放射科团队评分，然后由两名放射科专家独立复查。评估创伤中心放射科医生与专家复查人员之间以及两名独立专家之间的观察者间一致性。该研究还检查了损伤严重程度的低估是否影响早期临床结果。
创伤中心放射科医生与专家复查人员之间的一致性为中等，线性加权的kappa系数为0.493，二次加权的kappa系数为0.511，而专家间一致性极佳（kappa：线性0.905，二次0.917）。不一致的主要来源是实质去血管化的低估，这经常导致4级损伤被误分类为3级。虽然正确分类和错误分类的患者在第5天的总体并发症无显著差异（p = 0.0593），但损伤被低估（假阴性）的患者出血并发症风险是其余队列的三倍（p = 0.0351）。
本研究强调了AAST-OIS评分在紧急创伤情况下的可重复性中等，强调需要标准化评估方案以提高诊断一致性。鉴于低估病例中出血并发症风险较高，提高对实质去血管化的认识和改进放射学培训对于优化患者结局至关重要。基于人工智能的决策支持工具和结构化报告模板的整合可能会增强实时损伤分类并减少观察者变异性。
