Stephanie A Savage1, Christopher S Klekar2, Elisa L Priest2, Marie L Crandall3, Briana C Rodriguez4, Shahid Shafi2. 1. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN. Electronic address: ssavage1@uthsc.edu. 2. Institute for Health Care Research and Improvement, Baylor Scott & White Health, Dallas, Texas. 3. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. 4. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
Abstract
BACKGROUND: The American Association for the Surgery of Trauma (AAST) recently developed a grading scale for measuring anatomic severity of emergency general surgery (EGS) diseases. Grades were developed by expert consensus and have not been validated. The study purpose was to measure inter-rater reliability of the grading scale using colonic diverticulitis and to measure the association between disease grade and patient outcomes. METHODS: All charts were reviewed and independently assigned AAST grades based on specific disease criteria. Inter-rater reliability was measured using a kappa coefficient. Multivariate regression models were used to determine the relationship between AAST disease grade and patient outcomes adjusted for age, comorbidities, and patient physiology. RESULTS: Over 70% of patients demonstrated mild disease (grades I and II). No deaths were encountered. Inter-rater reliability for grade assignment was moderate (kappa coefficient, 0.43; 95% confidence interval, 0.31-0.56), with 67% concordance in grades. Compared to grade I, complications were similar in grade II but increased significantly with higher grades (grade III odds ratio [OR], 3.13 [1.32-7.41]; grade IV OR, 8.18 [2.09-32.0]; and grade V OR, 10.2 [2.68-38.90]). Compared to grade I, length of stay increased with higher grades (grade II incidence rate ratio [IRR], 1.30 [1.07-1.60]; grade III IRR, 2.4 [1.93-2.98]; grade IV IRR, 3.2 [2.27-4.60]; and grade V IRR, 2.6 [1.82-3.60]). CONCLUSIONS: The EGS grading scale for diverticulitis demonstrated moderate inter-rater reliability. Higher grades were independently associated with complications and length of stay. The findings provide a positive validation that the EGS scale is easily used and effective.
BACKGROUND: The American Association for the Surgery of Trauma (AAST) recently developed a grading scale for measuring anatomic severity of emergency general surgery (EGS) diseases. Grades were developed by expert consensus and have not been validated. The study purpose was to measure inter-rater reliability of the grading scale using colonic diverticulitis and to measure the association between disease grade and patient outcomes. METHODS: All charts were reviewed and independently assigned AAST grades based on specific disease criteria. Inter-rater reliability was measured using a kappa coefficient. Multivariate regression models were used to determine the relationship between AAST disease grade and patient outcomes adjusted for age, comorbidities, and patient physiology. RESULTS: Over 70% of patients demonstrated mild disease (grades I and II). No deaths were encountered. Inter-rater reliability for grade assignment was moderate (kappa coefficient, 0.43; 95% confidence interval, 0.31-0.56), with 67% concordance in grades. Compared to grade I, complications were similar in grade II but increased significantly with higher grades (grade III odds ratio [OR], 3.13 [1.32-7.41]; grade IV OR, 8.18 [2.09-32.0]; and grade V OR, 10.2 [2.68-38.90]). Compared to grade I, length of stay increased with higher grades (grade II incidence rate ratio [IRR], 1.30 [1.07-1.60]; grade III IRR, 2.4 [1.93-2.98]; grade IV IRR, 3.2 [2.27-4.60]; and grade V IRR, 2.6 [1.82-3.60]). CONCLUSIONS: The EGS grading scale for diverticulitis demonstrated moderate inter-rater reliability. Higher grades were independently associated with complications and length of stay. The findings provide a positive validation that the EGS scale is easily used and effective.
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Authors: Stephanie A Savage; Shi Wen Li; Garth H Utter; Jessica A Cox; Salina M Wydo; Kevin Cahill; Babak Sarani; Jeremy Holzmacher; Therese M Duane; Rajesh R Gandhi; Martin D Zielinski; Mohamed Ray-Zack; Joshua Tierney; Trinette Chapin; Patrick B Murphy; Kelly N Vogt; Thomas J Schroeppel; Emma Callaghan; Leslie Kobayashi; Raul Coimbra; Kevin M Schuster; Devin Gillaspie; Lava Timsina; Alvancin Louis; Marie Crandall Journal: J Trauma Acute Care Surg Date: 2019-04 Impact factor: 3.313
Authors: Matthew C Hernandez; Victor Y Kong; John L Bruce; Johnathon M Aho; Grant L Laing; Martin D Zielinski; Damian L Clarke Journal: World J Surg Date: 2018-11 Impact factor: 3.352