Page 99 - Journal of Special Operations Medicine - Summer 2015

Table 3 Total Injuries Recorded in Each Anatomic Region Figure 2 Reproducibility of Injury Severity Score (ISS)
Compared Between Joint Theatre Trauma Registry (JTTR) between Joint Theatre Trauma Registry (JTTR) and
and Study Investigators investigators.
Injuries Recorded Injuries Recorded
According to by Investigators,
AIS Region JTTR, No. No.
Head 25 11
Face 23 14
Neck 0 1
Thorax 19 16
Abdomen 29 37
Spine 9 4
Upper extremity 29 35
Lower extremity 75 81
External 5 13
Figure 3 Reproducibility of New Injury Severity Score
Other 0 0
(NISS) between Joint Theatre Trauma Registry (JTTR)
Note: AIS, Abbreviated Injury Scale. and investigators.
not met, with differences in scores lying outside 2 SDs of
the mean difference in two of 32 cases (6.25%) (Figure
2 and 3). However, there was no evidence of a system-
atic difference in assigned ISS and NISS values within
our sample.

Weighted κ indexes of interrater agreement of 0.88 (p
< .001) “almost perfect,” 0.41 (p = .02) “moderate,”
and 0.63 (p < .001) “substantial” were obtained for
maxAIS(M), ISS, and NISS, respectively. ICC indexes of
consistency in single scores were “almost perfect,” with
ICCs of 0.89 (95% CI, 0.78–0.94), 0.94 (95% CI, 0.88–
0.97), and 0.84 (95% CI, 0.70–0.92) for maxAIS(M),
ISS, and NISS, respectively. At the lower bounds of the
CI, the reliability for maxAIS(M) and NISS remained injury scores by reviewer, weighted κ, and ICC statistics
24
“substantial” (ICC, 0.61–0.80 ). Summary statistics for are given in Table 5. The distributions of comparative
ISS and NISS scores are shown in
Table 4 Percentage Agreement and Interobserver Reliability of Maximum Regional Figures 4 and 5.
Abbreviated Injury Scale (Military Version)
Agreement, Degree of Agreement at Discussion
Region % ICC (95% CI) Lower CI Extreme
This is the first study to assess
Head 87.5 0.908 (0.902–0.976) Almost perfect
interobserver variability of in-
Face 81.3 0.746 (0.544–0.867) Moderate jury severity scoring in a modern
Neck 96.9 0.000 (−0.340–0.342) None combat hospital. The main find-
ing of this study is that, during
Thorax 84.4 0.953 (0.906–0.977) Almost perfect
the period of observation, there
Abdomen 75.0 0.881 (0.772–0.940) Substantial were discrepancies in the AIS(M)
Spine 93.8 0.579 (0.297–0.769) Fair recorded for the same patients
Upper 81.3 0.883 (0.775–0.941) Substantial between TNCs and treating clini-
extremity cians. In addition to disagreement
in injury scores, there were further
Lower 68.8 0.767 (0.578–0.879) Moderate
extremity differences in the total number of
injuries and in both regional and
External 81.3 0.844 (0.707–0.921) Substantial
total injury burdens. However,
Note: CI, confidence interval; ICC, intraclass correlation coefficient.
this should not be interpreted as a

Variability in Injury Severity Scoring After Combat Trauma 89