title: [Assessment of injury severity at the accident scene by the emergency physician: utility of technical crash parameters: results of a pilot study].
abstract: BACKGROUND
  Technical parameters of road traffic crashes are routinely documented by emergency physicians on scene. It is, however, unclear whether this information contributes to the estimation of injury severity of vehicle drivers.
  
  
  METHODS
  In this study, three experienced emergency physicians were asked to predict the injury severity of vehicle drivers [categorized according to Injury Severity Score (ISS) values of <16 and ≥16 as moderate to severe or life-threatening] based on increasingly complex technical crash information, ranging from routine variables to photo documentation of the crash scene. A sample of 100 cases (mean ISS 23.6±26.9) was obtained from the prospective database of an in-depth technical and medical car crash research project conducted in the northeastern part of Germany. Statistical analysis comprised inter-rater agreement beyond chance (kappa values) and indicators of diagnostic test accuracy (i.e. sensitivity, specificity and so on).
  
  
  RESULTS
  The inter-rater agreement of injury severity based on technical crash information was moderate to substantial (kappa 0.42-0.66). Amongst the three observers and various amounts of technical data, sensitivity ranged between 18 and 80%, and specificity ranged between 41 and 89% in predicting the presence of major trauma. Presentation of photographs from the crash scene increased diagnostic accuracy. Still, the presented information led to a shift from a 50% prior probability of life-threatening injuries to a maximum of 40% in the negative and 67% in the positive case.
  
  
  CONCLUSIONS
  Neither basic technical parameters that are easy to obtain after a car crash nor additional technical information markedly contribute to the emergency physician's estimation of a vehicle driver's injury severity. The presented results should be supported by a subsequent study including a larger sample.
authors.affiliation: Abteilung für Unfall- und Wiederherstellungschirurgie, Klinik und Poliklinik für Chirurgie, Universitätsmedizin Greifswald, Deutschland. gerrit.matthes@ukb.de
authors.forename: G
authors.initials: G
authors.lastname: Matthes
authors.forename: U
authors.initials: U
authors.lastname: Schmucker
authors.forename: M
authors.initials: M
authors.lastname: Frank
authors.forename: C
authors.initials: C
authors.lastname: Huwer
authors.forename: A
authors.initials: A
authors.lastname: Ekkernkamp
authors.forename: D
authors.initials: D
authors.lastname: Stengel
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D015588:Observer Variation; D010820:Physicians / Q000706:statistics & numerical data*; D015995:Prevalence; D011361:Professional Competence / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000453:epidemiology*