PREVENTABLE DEATH CLASSIFICATION - INTERRATER RELIABILITY AND COMPARISON WITH ISS-BASED SURVIVAL PROBABILITY ESTIMATES

The purpose of the study was to compare the injury-related threat to s urvival estimated by the Injury Severity Score (ISS) and a committee o f experts. The charts of 116 (73 fatalities and 43 survivors) patients with severe injuries were reviewed. A committee of nine clinicians cl assified each case as survivable, potentially survivable, and nonsurvi vable based on anatomical descriptors, mechanism of injury, and patien t's age. Majority was used to determine the final committee classifica tion. Based on the ISS values, cases were classified as survivable (9- 24), potentially survivable (25-49), and nonsurvivable (>49). The resu lts showed poor interrater reliability among the nine clinicians with an overall intraclass correlation coefficient of 0.43. The ISS-based c lassification had high agreement with the final committee classificati on (overall weighted kappa = 0.71). Lower agreement was observed for f alls and with increasing number of in juries. This study has demonstra ted no additional benefit for using a committee to classify injury sev erity on the basis of anatomical damage over applying ISS-based surviv al probabilities. The continued use of the ISS is supported.