Abstracts

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1156. Does the Time From CT to Surgery Impact a Change in AAST Trauma Scores for Hepatic and Splenic Injuries?
Authors * Denotes Presenting Author
  1. Frank Santisi *; Cooper Medical School of Rowan University
  2. Mark DiMarcangelo; Cooper Medical School of Rowan University; Cooper University Hospital
  3. Ron Gefen; Cooper Medical School of Rowan University; Cooper University Hospital
Objective:
The American Association for the Surgery of Trauma (AAST) injury scoring scales are used to objectively assess traumatic injuries. Initial injury scores are often diagnosed on CT scans, and may also be graded at surgical intervention. The objectives of this study were: to compare the AAST scale grades assigned on CT by the radiology department with post-intervention scores assigned by the trauma department, and to determine if the time between imaging and surgical intervention had an effect on the concordance between radiology and trauma grades.

Materials and Methods:
An IRB approved retrospective analysis of patients from a trauma registry at CUH was performed on patients admitted between 2012 and 2017 with liver or spleen injuries. Inclusion criteria were patients who received an initial CT scan of the abdomen and pelvis as well as surgical grading at abdominal surgery. Two attending radiologists retrospectively graded the CT reports while blinded to the original score, with Kappa (K) value used to determine agreement. The inter-rater agreement between the 3 groups (original radiology, retrospective radiology, and trauma surgery) were calculated with both Kappa agreement and intraclass correlation coefficient (ICC). Using a t-test it was determined if time between imaging and intervention was significantly different between agreeing and disagreeing scores.

Results:
There was moderate agreement between original CT grade and surgical grade for liver injuries (K=0.57), and good agreement for splenic injuries (K=0.66). Inter-rater agreement was substantial for splenic injuries (K=0.66) and only fair for liver injuries (K=0.39). ICC had excellent (0.88) agreement for splenic injuries and good (0.68) agreement for liver injuries. The mean time from CT to surgery was 114 minutes (SD 109) for injuries with concordant grades, and 150 minutes (SD 230) for injuries with discordant grades (t = -0.65, p = 0.52).

Conclusion:
Radiology CT reports had moderate to good agreement with surgical grades for liver and spleen injuries overall, aligned with findings in prior literature. The inter-rate agreement showed excellent agreement for splenic injuries, while the hepatic injuries had good-fair agreement. There was no significant difference in the time lag between imaging and surgery for injuries with concordant or discordant trauma grades. However, there was a non-significant trend towards a longer time to surgery in discordant grades. These results do not show that the time to surgery is related to a change in trauma grading at surgery compared to initial CT.