Inter-radiologist Agreement for CT Scoring of Pediatric Splenic Injuries and Effect on an Established Clinical Practice Guideline

Overview

Journal Pediatr Radiol

Specialty Pediatrics

Date 2015 Oct 21

PMID 26481335

Citations 5

Authors

Jessica R Leschied

Michael B Mazza

Matthew Davenport

Suzanne T Chong

Ethan A Smith

Carrie N Hoff

Maria F Ladino-Torres

Shokoufeh Khalatbari

Peter F Ehrlich

Jonathan R Dillman

Affiliations

Soon will be listed here.

Abstract

Background: The American Pediatric Surgical Association (APSA) advocates for the use of a clinical practice guideline to direct management of hemodynamically stable pediatric spleen injuries. The clinical practice guideline is based on the CT score of the spleen injury according to the American Association for the Surgery of Trauma (AAST) CT scoring system.

Objective: To determine the potential effect of radiologist agreement for CT scoring of pediatric spleen injuries on an established APSA clinical practice guideline.

Materials And Methods: We retrospectively analyzed blunt splenic injuries occurring in children from January 2007 to January 2012 at a single level 1 trauma center (n = 90). Abdominal CT exams performed at clinical presentation were reviewed by four radiologists who documented the following: (1) splenic injury grade (AAST system), (2) arterial extravasation and (3) pseudoaneurysm. Inter-rater agreement for AAST injury grade was assessed using the multi-rater Fleiss kappa and Kendall coefficient of concordance. Inter-rater agreement was assessed using weighted (AAST injury grade) or prevalence-adjusted bias-adjusted (binary measures) kappa statistics; 95% confidence intervals were calculated. We evaluated the hypothetical effect of radiologist disagreement on an established APSA clinical practice guideline.

Results: Inter-rater agreement was good for absolute AAST injury grade (kappa: 0.64 [0.59–0.69]) and excellent for relative AAST injury grade (Kendall w: 0.90). All radiologists agreed on the AAST grade in 52% of cases. Based on an established clinical practice guideline, radiologist disagreement could have changed the decision for intensive care management in 11% (10/90) of children, changed the length of hospital stay in 44% (40/90), and changed the time to return to normal activity in 44% (40/90).

Conclusion: Radiologist agreement when assigning splenic AAST injury grades is less than perfect, and disagreements have the potential to change management in a substantial number of pediatric patients.

Citing Articles

Splenic injury from blunt trauma.

Wiik Larsen J, Thorsen K, Soreide K Br J Surg. 2023; 110(9):1035-1038.

PMID: 36916679 PMC: 10416674. DOI: 10.1093/bjs/znad060.

The management and outcome of paediatric splenic injuries in the Netherlands.

Grootenhaar M, Lamers D, Ulzen K, de Blaauw I, Tan E World J Emerg Surg. 2021; 16(1):8.

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Splenic injury severity, not admission hemodynamics, predicts need for surgery in pediatric blunt splenic trauma.

Teuben M, Spijkerman R, Teuber H, Pfeifer R, Pape H, Kramer W Patient Saf Surg. 2020; 14:1.

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Can time to healing in pediatric blunt splenic injury be predicted?.

Dickinson C, Vidri R, Smith A, Wills H, Luks F Pediatr Surg Int. 2018; 34(11):1195-1200.

PMID: 30194477 DOI: 10.1007/s00383-018-4341-2.

Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study.

Bruhn P, Osterballe L, Hillingso J, Svendsen L, Helgstrand F Scand J Trauma Resusc Emerg Med. 2016; 24(1):104.

PMID: 27561373 PMC: 5000516. DOI: 10.1186/s13049-016-0297-1.

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