K. B. Savoie1, N. Jain2, R. F. Williams1 1University Of Tennessee Health Science Center,Department Of Surgery,Memphis, TN, USA 2University Of Tennessee Health Science Center,College Of Medicine,Memphis, TN, USA
Introduction:
The value of the American Association for the Surgery of Trauma (AAST) Organ Injury Scaling (OIS) system has been beneficial in managing solid organ injuries in adults. However, OIS may not correlate with pediatric solid organ injuries and thus may be inconsistently used at pediatric institutions. We hypothesized that radiologists inconsistently assign OIS grades for pediatric blunt solid organ injuries.
Methods:
All patients with blunt liver, spleen, and kidney organ injuries from a January 2009 to December 2014 at an urban tertiary pediatric hospital were identified from an institutional trauma database. Demographic information, imaging, radiologic grade of injury, and surgical grade of injury were collected. Spearman’s correlation and weighted Kappa was used to evaluate radiologist and surgeon’s grading agreement of the injuries.
Results:
A total of 352 patients were identified; OIS grading was assigned to 73% of patients; 37% had grading by a radiologist and 66% by a surgeon. Liver: 128/179 injuries were graded. 56 patients had grading by both radiologists and surgeons with a Spearman correlation of 0.70 and a weighted kappa of 0.59 (figure). OIS was associated with overall need for intervention (p <0.01) and specifically for need for transfusion (p <0.01) and operative intervention (p = 0.02); it was not associated with need for angiography. Spleen: 97/126 injuries were graded. 41 patients had grading by both radiologist and surgeons with a Spearman correlation of 0.93 and a weighted kappa of 0.86. Kidney: 30/47 injuries were graded. 9 patients had grading by both radiologist and surgeons with a Spearman correlation of 0.82 and a weighted kappa of 0.67. For spleen and renal injuries there was no correlation between OIS grade and need for overall intervention (spleen p=0.12, renal p=0.23) or specific types of intervention. There was no correlation between grade and complications for any type of injury.
Conclusion:
Pediatric surgeons utilized OIS more frequently than pediatric radiologists; there was higher correlation for spleen and renal injuries. Although OIS was associated with need for intervention in liver injuries, it was not associated with interventions for spleen and renal or for complications for any type of injury. Efforts to increase utilization or the development of a pediatric specific grading system may help standardize care for pediatric trauma patients.
