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

• Published in: European journal of trauma and emergency surgery (Munich : 2007) Vol. 48; no. 1; pp. 367 - 372
• Main Authors: Horst, Klemens, Lichte, Philipp, Bläsius, Felix, Weber, Christian David, Tonglet, Martin, Kobbe, Philipp, Heussen, Nicole, Hildebrand, Frank
• Format: Journal Article Web Resource
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2022; Springer Nature B.V; Urban & Vogel GmbH
• Subjects: Bleeding; Blood Coagulation Disorders - diagnosis; Blood Coagulation Disorders - therapy; Blood Transfusion; Blood transfusions; Chirurgie; Coagulation; Critical Care Medicine; Emergency medical care; Emergency Medicine; Health risks; Human health sciences; Humans; Intensive; Inter-rater reliability; Massive transfusion; Medicine; Medicine & Public Health; Multiple Trauma; Original; Original Article; Polytrauma; Reliability; Reproducibility of Results; Sciences de la santé humaine; Shock; Sports Medicine; Surgery; Surgical Orthopedics; TICCS; Transfusion; Trauma; Trauma Centers; Traumatic Surgery; Shock; Massive transfusion; Multiple trauma; Inter-rater reliability; mTICCS; Transfusion; Polytrauma; Reliability; Bleeding; TICCS
• ISSN: 1863-9933; 1863-9941; 1863-9941
• DOI: 10.1007/s00068-020-01523-w

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.