Pediatric Radiology

, Volume 46, Issue 2, pp 229–236 | Cite as

Inter-radiologist agreement for CT scoring of pediatric splenic injuries and effect on an established clinical practice guideline

  • Jessica R. LeschiedEmail author
  • Michael B. Mazza
  • Matthew S. Davenport
  • Suzanne T. Chong
  • Ethan A. Smith
  • Carrie N. Hoff
  • Maria F. Ladino-Torres
  • Shokoufeh Khalatbari
  • Peter F. Ehrlich
  • Jonathan R. Dillman
Original Article



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.


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.


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).


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.


Children Clinical practice guidelines Computed tomography Injury score Spleen Trauma 


Compliance with ethical standard

Conflicts of interest

Dr. M. Davenport has book contracts with Lippincott Williams & Wilkins, and Elsevier.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Jessica R. Leschied
    • 1
    Email author
  • Michael B. Mazza
    • 2
  • Matthew S. Davenport
    • 3
  • Suzanne T. Chong
    • 2
  • Ethan A. Smith
    • 1
  • Carrie N. Hoff
    • 2
  • Maria F. Ladino-Torres
    • 1
  • Shokoufeh Khalatbari
    • 4
  • Peter F. Ehrlich
    • 5
  • Jonathan R. Dillman
    • 1
  1. 1.Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children’s HospitalUniversity of Michigan Health SystemAnn ArborUSA
  2. 2.Department of Radiology, Division of Emergency Radiology, C.S. Mott Children’s HospitalUniversity of Michigan Health SystemAnn ArborUSA
  3. 3.Department of Radiology, Division of Abdominal Imaging, C.S. Mott Children’s HospitalUniversity of Michigan Health SystemAnn ArborUSA
  4. 4.Michigan Institute for Clinical and Health ResearchUniversity of MichiganAnn ArborUSA
  5. 5.Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children’s HospitalUniversity of Michigan Health SystemAnn ArborUSA

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