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

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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.

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Authors and Affiliations

  1. Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children’s Hospital, University of Michigan Health System, Floor 3 Recp A Room 3660A, 1540 E. Hospital Drive SPC 4252, Ann Arbor, MI, 48109, USA

    Jessica R. Leschied, Ethan A. Smith, Maria F. Ladino-Torres & Jonathan R. Dillman

  2. Department of Radiology, Division of Emergency Radiology, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI, USA

    Michael B. Mazza, Suzanne T. Chong & Carrie N. Hoff

  3. Department of Radiology, Division of Abdominal Imaging, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI, USA

    Matthew S. Davenport

  4. Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA

    Shokoufeh Khalatbari

  5. Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI, USA

    Peter F. Ehrlich

Authors
  1. Jessica R. Leschied
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  2. Michael B. Mazza
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  3. Matthew S. Davenport
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  4. Suzanne T. Chong
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  5. Ethan A. Smith
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  6. Carrie N. Hoff
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  7. Maria F. Ladino-Torres
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  8. Shokoufeh Khalatbari
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  9. Peter F. Ehrlich
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  10. Jonathan R. Dillman
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Corresponding author

Correspondence to Jessica R. Leschied.

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Conflicts of interest

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

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Leschied, J.R., Mazza, M.B., Davenport, M.S. et al. Inter-radiologist agreement for CT scoring of pediatric splenic injuries and effect on an established clinical practice guideline. Pediatr Radiol 46, 229–236 (2016). https://doi.org/10.1007/s00247-015-3469-7

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  • DOI: https://doi.org/10.1007/s00247-015-3469-7

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