Inter- and Intrarater Reliability in Computed Axial Tomographic Grading of Splenic Injury: Why so Many Grading Scales?

Erik S. Barquist, Louis R. Pizano, William Feuer, Peter A. Pappas, Kimberly A. McKenney, Suzanne D. LeBlang, Robert P. Henry, Luis A. Rivas, Stephen M. Cohn

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Objective: After splenic trauma, critical decisions regarding operative intervention are often made with the aid of computed axial tomographic (CT) scan findings. No CT scan-based grading scale has been demonstrated to predict accurately which patients require operative or radiologic intervention for their splenic injuries. We hypothesized that use of the most common grading scale, the American Association for the Surgery of Trauma scale, would be associated with low intra- and interreliability scores. We assessed the ability of experienced trauma radiologists to differentiate grade III from grade IV splenic injuries. Methods: The films of patients who had undergone abdominal CT scanning before splenectomy for grade III or IV injuries were serially evaluated by four trauma radiology faculty weekly for 3 weeks. We assessed intra- and interrater reliability for grading and for presence of contrast blush. Results: Intrarater reproducibility yielded a weighted kappa score of 0.15 to 0.77. Interrater reliability weighted kappa scores ranged from 0 to 0.84, with a mean value of 0.23. Conclusion: CT imaging is not reliable for identifying grades III and IV splenic injury, as experienced radiologists often underestimate the magnitude of injury. Interrater reliability is poor. Factors other than the CT grade of splenic injury should determine whether patients require operative or angiographic therapy.

Original languageEnglish (US)
Pages (from-to)334-338
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number2
StatePublished - Jan 1 2004


  • Abdominal trauma
  • Computed axial tomographic (CT) scan
  • Injury grading
  • Spleen
  • Splenic injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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