mTICCS and its inter-rater reliability to predict the need for massive transfusion in severely injured patients

European Journal of Trauma and Emergency Surgery, vol. 48, pp. 367–372

Abstract

PURPOSE: The modified Trauma-Induced Coagulopathy Clinical Score (mTICCS) presents a new scoring system for the early detection of the need for a massive transfusion (MT). This easily applicable score was validated in a large trauma cohort and proven comparable to more established complex scoring systems. However, the inter-rater reliability of the mTICCS has not yet been investigated. METHODS: Therefore, a dataset of 15 randomly selected and severely injured patients (ISS ≥ 16) derived from the database of a level I trauma centre (2010-2015) was used. Moreover, 15 severely injured subjects that received MT were chosen from the same databank. A web-based survey was sent to medical professionals working in the field of trauma care asking them to evaluate each patient using the mTICCS. RESULTS: In total, 16 raters (9 residents and 7 specialists) completed the survey. Ratings from 15 medical professionals could be evaluated and led to an ICC of 0.7587 (95% Bootstrap confidence interval (BCI) 0.7149-0.8283). A comparison of working experience specific ICC (n = 7 specialists, ICC: 0.7558, BCI: 0.7076-0.8270; n = 8 residents, ICC: 0.7634, BCI: 0.7183-0.8335) showed no significant difference between the two groups (p = 0.67). CONCLUSION: In summary, reliability values need to be considered when making clinical decisions based on scoring systems. Due to its easy applicability and its almost perfect inter-rater reliability, even with non-specialists, the mTICCS might therefore be a useful tool to predict the early need for MT in multiple trauma.

Authors 8

1. Klemens Horst corresponding Aachen Department of Trauma and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany. khorst@ukaachen.de

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany

2. Philipp Lichte Aachen Department of Trauma and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany

3. Felix Bläsius Aachen Department of Trauma and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany

4. Christian David Weber Aachen Department of Trauma and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany

5. Martin Lucien Tonglet

   University of Liège · Centre Hospitalier Universitaire de Liège

   Affiliation as printed

   Department of Emergency, Liege University Hospital, Domaine du Sart Tilman, 4000, Liège, Belgium

   Department of Emergency, Liege University Hospital, Liège, Belgium

6. Philipp Kobbe Aachen Department of Trauma and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany

7. Nicole Maria Heussen Aachen Department of Medical Statistics

   Sigmund Freud Privatuniversität Wien · RWTH Aachen University

   Affiliation as printed

   Department of Medical Statistics, RWTH Aachen University, 52074, Aachen, Germany

   Medical School, Sigmund Freud Private University, 1020, Vienna, Austria

   Department of Medical Statistics, RWTH Aachen University, Aachen, Germany

   Medical School, Sigmund Freud Private University, Vienna, Austria

8. Frank Hildebrand Aachen Department of Trauma and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

   Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany