Validation of the revised 2018 AAST-OIS classification and the CT severity index for prediction of operative management and survival in patients with blunt spleen and liver injuries

• Published in: European radiology 2020-12, Vol.30 (12), p.6570-6581
• Main Authors: Morell-Hofert, Dagmar, Primavesi, Florian, Fodor, Margot, Gassner, Eva, Kranebitter, Veronika, Braunwarth, Eva, Haselbacher, Matthias, Nitsche, Ulrich Peter, Schmid, Stefan, Blauth, Michael, Öfner, Dietmar, Stättner, Stefan
• Format: Article
• Language: English
• Subjects: Abdominal Injuries; Accuracy; Adolescent; Adult; Biometry; Classification; Clinical decision making; Computed Tomography; Contrast media; Correlation; Decision making; Decision Support Systems, Clinical; Diagnostic Radiology; Diagnostic systems; Extravasation; Female; Humans; Imaging; Injuries; Injury Severity Score; Internal Medicine; Interventional Radiology; Liver; Liver - diagnostic imaging; Liver - injuries; Male; Management; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neuroradiology; Odds Ratio; Patients; Predictions; Predictive Value of Tests; Prognosis; Radiology; Retrospective Studies; Spleen; Spleen - diagnostic imaging; Spleen - injuries; Surgery; Tomography, X-Ray Computed; Trauma; Treatment Outcome; Ultrasound; United States; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - mortality; Young Adult
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-020-07061-8

Objectives Non-operative management (NOM) is increasingly utilised in blunt abdominal trauma. The 1994 American Association of Surgery of Trauma grading (1994-AAST) is applied for clinical decision-making in many institutions. Recently, classifications incorporating contrast extravasation such as the CT severity index (CTSI) and 2018 update of the liver and spleen AAST were proposed to predict outcome and guide treatment, but validation is pending. Methods CT images of patients admitted 2000–2016 with blunt splenic and hepatic injury were systematically re-evaluated for 1994/2018-AAST and CTSI grading. Diagnostic accuracy, diagnostic odds ratio (DOR), and positive and negative predictive values were calculated for prediction of in-hospital mortality. Correlation with treatment strategy was assessed by Cramer V statistics. Results Seven hundred and three patients were analysed, 271 with splenic, 352 with hepatic and 80 with hepatosplenic injury. Primary NOM was applied in 83% of patients; mortality was 4.8%. Comparing prediction of mortality in mild and severe splenic injuries, the CTSI (3.1% vs. 10.3%; diagnostic accuracy = 75.4%; DOR = 3.66; p  = 0.006) and 1994-AAST (3.3% vs. 10.5%; diagnostic accuracy = 77.9%; DOR = 3.45; p  = 0.010) were more accurate compared with the 2018-AAST (3.4% vs. 8%; diagnostic accuracy = 68.2%; DOR = 2.50; p  = 0.059). In hepatic injuries, the CTSI was superior to both AAST classifications in terms of diagnostic accuracy (88.7% vs. 77.1% and 77.3%, respectively). CTSI and 2018-AAST correlated better with the need for surgery in severe vs. mild hepatic (Cramer V = 0.464 and 0.498) and splenic injuries (Cramer V = 0.273 and 0.293) compared with 1994-AAST (Cramer V = 0.389 and 0.255; all p