title: Solid organ injury grading in trauma: accuracy of grading by surgical residents.
abstract: The American Association for the Surgery of Trauma developed an Organ Injury Scale for management of patients with splenic, kidney, or liver injuries. Despite widespread use of the guidelines, the person who determines the injury grade varies among institutions. Our purpose was to determine  the accuracy and interobserver agreement between surgical residents and a radiologist in grading solid organ injuries. We retrospectively reviewed patients with solid organ injuries from January 2009 to May 2010 and compared the grade of solid organ injuries by a single resident with grades  by a single blinded radiologist using a paired t test, analysis of variance, or Kruskal-Wallis. Computed tomography scans of 58 patients with splenic injuries, 43 with liver injuries, and 16 with kidney injuries were reviewed. Average grades for splenic injuries were 2.5 and 2.4 (radiologist/resident);  liver injuries, 2.6 and 2.1; and kidney injuries, 2.7 and 2.8. There were no significant differences in grading by the radiologist and resident for splenic and kidney injuries; however, equal values were only achieved in 43 and 38 per cent, respectively. There was a significant difference  (average rating difference 0.54, P = 0.0002) in grading between the radiologist and resident for liver injuries with only 35 per cent having equal values and the radiologist grading on average 0.5 points higher than the resident. No demographic, injury, or outcome variables were significantly  associated with interobserver variability (P > 0.05). Despite a significant difference for liver injury grading, interobserver agreement between residents and a single radiologist was low. Clinical implications and the impact on outcomes related to interobserver variations require  further study.
authors.affiliation: Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, North Carolina, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Powers
authors.forename: L Neal
authors.initials: LN
authors.lastname: Beard
authors.forename: Ashley
authors.initials: A
authors.lastname: Adams
authors.forename: Cyrus A
authors.initials: CA
authors.lastname: Kotwall
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Clancy
authors.forename: William W
authors.initials: WW
authors.lastname: Hope
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002983:Clinical Competence; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007396:Internship and Residency; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries*; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D009657:North Carolina; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed