Development and validation of the injury severity assessment survey parentreport - A new injury severity assessment survey

Objective: To develop and pilot test a telephone-based survey instrument th at enables parents to identify and characterize the body region and severit y of childhood injuries using the Abbreviated Injury Scale (AIS) scoring sy stem. Design: A prospective cross-sectional survey. Setting: The emergency department of an urban, tertiary care, pediatric tra uma center. Participants: One hundred forty-seven parents of children younger than 18 y ears and seen in the emergency department for acute treatment of an uninten tional injury. Interventions: None. Main Outcome Measure: The degree of agreement, measured as sensitivity, spe cificity, and kappa statistic, between medical record information and paren ts' responses to the telephone survey regarding the identification and char acterization of clinically significant (AIS greater than or equal to 2) inj uries. Results: The survey, known as the Injury Severity Assessment Survey/Parent Report, was developed via a systematic review of the AIS 1990 manual. Answe rs to questions were developed in a way that enabled automated coding of re sponses into AIS scores or ranges of scores. The sensitivity of the survey (its ability to detect injuries scoring 2 or more on the AIS that were docu mented in the medical record) varied somewhat by the body region of injury, ranging from 88% for head, face, neck, and spine injuries to 95% for extre mity injuries. Intermediate sensitivity (92%) was noted for the detection o f significant chest and abdomen injuries. The specificity of the survey (it s ability to rule out the presence of a significant injury when one was not documented in the medical record) was more than 95% in each of the 3 body region groups. The kappa statistics for the 3 body region groups ranged fro m 0.89 to 0.92. Conclusions: A new telephone-based survey has been developed that enables p arents to characterize their child's injuries by body region and to differe ntiate between minor injuries and more significant injuries using a well-es tablished injury classification system. This survey has a significant advan tage over previous telephone-based or written surveys of childhood injuries and may be particularly valuable in population-based (eg, random-digit dia l surveys) or multi-institutional studies of pediatric injuries.