Inter-rater reliability of the Injury Severity Score and Abbreviated Injury Score

Tepas, III, J. J.; Crooms, C. B.; Mollitt, D. L.; String, D. L.; Ramenofsky, M. L.; Kitchens, L.; DiScala, Carla

Affiliations

¹Division of Pediatric Surgery, University of Florida Health Science Center Jacksonville, Jacksonville, Florida USA

²Division of Pediatric Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania USA

³San Diego Children's Hospital, San Diego, California USA

⁴Department of Rehabilitation Medicine, Tufts-New England Medical Center, Boston, Massachusetts USA

Abstract

The inter-rater reliability of the Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS) was evaluated by comparing codes entered in four pediatric trauma registries to those reassigned by an independent AIS coder. The 200 cases analyzed demonstrated an incidence of ISS agreement of 37% with a mean difference of 4.6 points + 10.1. 876 diagnoses were also compared and documented an incidence of agreement of 83.1%. 12.4% of AIS codes were downgraded, while only 4.5% were upgraded in severity. The abdominal region demonstrated the highest degree of inconsistency (40%), followed by thoracic (30%), head and neck (26%), facial (17%), external (16%), and extremity/spine (15%) regions. This study suggests a low inter-rater reliability in the determination of the AIS for the pediatric population. The variances detected in AIS are magnified in calculation of the ISS, potentially undermining accurate outcome assessment.

Cited Works (1)

Year	Entry
1987	Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. J Trauma. April 1987;27(4):370-378.

Cited By (1)

Year	Entry
1991	Copes WS, Dickman FB, Champion HR, Sacco WJ. Motorcycle injuries: an MTOS perspective. In: 35th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 7, 1991; Toronto, Canada.269-284.