Inter-rater reliability in the radiological classification of renal injuries

Pretorius, Elias; Zarrabi, Amir; Griffith‐Richards, Stephanie; Harvey, Justin; Ackermann, Hilgard; Meintjes, Catharina M.; Cilliers, Willem G.; Zunza, Moleen; Szpytko, Alexander; Pitcher, R

doi:10.1007/s00345-017-2166-6

Cited by 4 publications

(3 citation statements)

References 45 publications

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“…Additionally, in their study, grading agreements were lower between different specialties compared with readers from the same specialty. Pretorius et al 27 reported slightly higher intradisciplinary and interdisciplinary agreements in grading the renal injuries; however, the agreement for specific AAST grades were still low especially for grade IVand V injuries. These findings demonstrate the interdisciplinary differences in interpretation of the grading system and the need for a more clear and objective grading system that will have higher reproducibility.…”

Section: Discussionmentioning

confidence: 97%

“…An ideal renal injury classification system should be based on well-defined and objective criteria. 25,27 Using clinically relevant radiographic findings that are easy to identify and measure can also help to decrease subjectivity in grading and facilitate reader training. 27 By including some of the important radiographic findings, such as active bleeding and hematoma characteristics in the grading system, the 2018 revisions provide a more clinically relevant classification of renal injuries (Table 1).…”

Section: Discussionmentioning

confidence: 99%

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The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions

Keihani

Rogers

Putbrese

et al. 2019

J Trauma Acute Care Surg

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BACKGROUND:In 2018, the American Association for the Surgery of Trauma (AAST) published revisions to the renal injury grading system to reflect the increased reliance on computed tomography scans and non-operative management of high-grade renal trauma (HGRT). We aimed to evaluate how these revisions will change the grading of HGRT and if it outperforms the original 1989 grading in predicting bleeding control interventions. METHODS:Data on HGRTwere collected from 14 Level-1 trauma centers from 2014 to 2017. Patients with initial computed tomography scans were included. Two radiologists reviewed the scans to regrade the injuries according to the 1989 and 2018 AAST grading systems. Descriptive statistics were used to assess grade reclassifications. Mixed-effect multivariable logistic regression was used to measure the predictive ability of each grading system. The areas under the curves were compared. RESULTS:Of the 322 injuries included, 27.0% were upgraded, 3.4% were downgraded, and 69.5% remained unchanged. Of the injuries graded as III or lower using the 1989 AAST, 33.5% were upgraded to grade IV using the 2018 AAST. Of the grade V injuries, 58.8% were downgraded using the 2018 AAST. There was no statistically significant difference in the overall areas under the curves between the 2018 and 1989 AAST grading system for predicting bleeding interventions (0.72 vs. 0.68, p = 0.34). CONCLUSION:About one third of the injuries previously classified as grade III will be upgraded to grade IV using the 2018 AAST, which adds to the heterogeneity of grade IV injuries. Although the 2018 AAST grading provides more anatomic details on injury patterns and includes important radiologic findings, it did not outperform the 1989 AAST grading in predicting bleeding interventions.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions

Keihani

Rogers

Putbrese

et al. 2019

J Trauma Acute Care Surg

View full text Add to dashboard Cite

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“…The expansion of the AAST classification to include CT-identified injury patterns removes ambiguity in assigning grades and maintains inter-rater reliability. 31 The revision committee acknowledged that the grade of injury, in the presence of vascular trauma, maybe higher than the previously described parenchymal-based injury. Also, the committee recognized that vascular injuries are associated with higher NOM failure rate.…”

Section: Workflowmentioning

confidence: 98%

The Role of Dual-Energy CT in Solid Organ Injury

Abu-Omar,

Murray,

Ali

et al. 2023

Can Assoc Radiol J

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The liver, spleen, and kidneys are the commonest injured solid organs in blunt and penetrating trauma. The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) is the most widely accepted system for categorizing traumatic injuries. Grading systems allow clear communication of findings between clinical teams and assign a measurable severity of injury, which directly correlates with morbidity and mortality. The 2018 revised AAST OIS emphasizes reliance on CT for accurate grading; in particular regarding vascular injuries. Dual-Energy CT (DECT) has emerged as a promising tool with multiple clinical applications already demonstrated. In this review article, we summarize the basic principles of CT attenuation to refresh the minds of our readers and we scrutinize DECT’s technology as opposed to conventional Single-Energy CT (SECT). This is followed by outlining the benefits of various DECT postprocessing techniques, which authors of this article refer to as the 3Ms (Mapping of Iodine, Material decomposition, and Monoenergetic virtual imaging), in aiding radiologists to confidently assign an OIS as well as problem solve complex injury patterns. In addition, a thorough discussion of changes to the revised AAST OIS focusing on definitions of key terms used in reporting injuries is described.

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Grading Abdominal Trauma: Changes in and Implications of the Revised 2018 AAST-OIS for the Spleen, Liver, and Kidney

Dixe de Oliveira Santo,

Sailer,

Solomon

et al. 2023

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Inter-rater reliability in the radiological classification of renal injuries

Abstract: The finding of substantial IRR amongst radiologists and urologists utilizing the AAST system supports continued use of the broad parameters of the AAST system, with some modification in specific categories with lower agreement.

Cited by 4 publications

References 45 publications

The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions

The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions

The Role of Dual-Energy CT in Solid Organ Injury

Grading Abdominal Trauma: Changes in and Implications of the Revised 2018 AAST-OIS for the Spleen, Liver, and Kidney

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