Preventable death classification:​ inter rater reliability and comparison with ISS based survival probability estimates

Sampalis, John S.; Lavoie, Andre; Nikolis, Andreas

Affiliations

¹Department of Surgery, Trauma Epidemiology, McGill University, Montreal, Quebec

²Urgences-Sante, Montreal, Quebec

Abstract

The purpose of the study was to assess the validity of ISS probabilities as indicators of preventable trauma deaths. The charts of 116 (73 facilities and 43 survivors of severe injuries) were reviewed. Nine clinicians classified each case as survivable, potentially survivable, and non-survivable. The ISS was used to classify cases as survivable (924), potentially survivable (25-49), and non-survivable (>49). The results showed poor inter-rater reliability among the clinicians (ICC:0. 150.74). The ISS classification had high agreement with the committee classification (weighted Kappa= 0.71). Low agreement was observed for falls and with increasing number of injuries. This study has demonstrated no additional benefit by using a committee to classify injured patients over applying ISS survival probabilities. The continued use of the ISS is supported.

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