Accuracy of the AAST organ injury scale for CT evaluation of traumatic liver and spleen injuries

ObjectiveDetection of abdominal injury is a very important component in trauma management so a precise assessment of liver and spleen injuries including their severity degree is necessary. There is a good case to believe that in emergency situations the radiologists’ performance may profit from a systematic approach using established scoring systems. Score systems as the organ injury scale (OIS) drawn up by the American Association for the Surgery of Trauma are a valuable guidance for objective trauma assessment. Aim of this study was to evaluate retrospectively whether a structured approach using the OIS may help improve trauma assessmentMethodsFifty-three patients, 38 male and 15 female who underwent CT and laparotomy after abdominal trauma were included in this study. The laparotomy was performed by experienced surgeons with a minimum experience of 6 years. While the original CT reports were written by different radiologists with a minimum experience of 3 years, and then a radiologist with experience of 4 years reviewed the same original CT pictures, resulting in the structured report. Both the original and structured CT results on liver and spleen injuries were transferred into OIS grades. Finally, the initial and structured CT results were compared with the intraoperative findings gathered from the surgery report.ResultsRegarding the original CT report we found a mean divergence of 0.68 ± 0.8 (r = 0.45) to the OIS finding in the surgery report for liver injuries (0.69 ± 1.17 for spleen injuries; r = 0.69). In comparison with the structured approach, where we detected a divergence of 0.8 ± 0.68; r = 0.63 (0.47 ± 0.77 for spleen injuries; r = 0.91), there was no significant difference. However we detected a lower rate of over-diagnosis in structured approaches.ConclusionOur study shows that a structured approach to triage abdominal trauma using an imaging checklist does not lead to a significantly higher detection rate, but a nonsignificant trend to reduce the rate of overdiagnoses, thus being more precise in grading the severity grade. Concerning the bias by retrospective study design, further prospective investigations are needed to evaluate the impact of trauma scores on the workflow in emergency department procedure as structured reporting systems are a valuable guidance in other radiological disciplines.