title: Organ laceration grading adherence by radiologists.
abstract: American Association for the Surgery of Trauma (AAST) abdominopelvic organ laceration grading is used to determine which patients can be managed non-operatively. We assess a change in the use of AAST grading system by radiologists at a single, large, academic institution before and after a one-time departmental intervention and reviewed non-graded reports evaluating if grading could be inferred. After IRB approval, a keyword search for "laceration" identified traumatic abdominopelvic CT reports in a 2-year period before and after the one-time intervention. Reports were reviewed to determine if an organ laceration was seen, if it was graded by AAST criteria, and if grading could be inferred for non-graded reports. T test was performed to assess statistical significance. Before the intervention, 348 reports contained the keyword "laceration," 81 with lacerations, 31 graded (38 %). After the intervention, 302 reports were found, 79 with lacerations, 59 graded (75 %). The increase was statistically significant (p < 0.0001). A decreasing trend in grading was seen over time following the intervention. Two out of 50 (4 %) pre-intervention and four out of 20 (20 %) post-intervention reports gave enough detailed descriptions for the grading to be inferred when it was not explicitly stated. Non-graded reports did not describe laceration parenchymal depth and subcapsular hematoma surface area percentage; however, the presence/absence of active extravasation, omitted in the 20-year-old AAST grading scheme, was described in every report. One-time departmental intervention yielded a significant increase in adherence to AAST laceration grading. Lack of perfect compliance, which diminished over time, suggests a need for further reinforcement.
authors.affiliation: Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT, 06520-8042, USA, vivekkalramd@gmail.com.
authors.forename: Vivek Bihari
authors.initials: VB
authors.lastname: Kalra
authors.forename: Xiao
authors.initials: X
authors.lastname: Wu
authors.forename: Jamal
authors.initials: J
authors.lastname: Bokhari
authors.forename: Howard
authors.initials: H
authors.lastname: Forman
mesh_terms: D000007:Abdominal Injuries / Q000145:classification* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D022125:Lacerations / Q000145:classification* / Q000000981:diagnostic imaging*; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000145:classification* / Q000000981:diagnostic imaging*