mTICCS and its inter-rater reliability to predict the need for massive transfusion in severely injured patients
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ORIGINAL ARTICLE
mTICCS and its inter‑rater reliability to predict the need for massive transfusion in severely injured patients Klemens Horst1 · Philipp Lichte1 · Felix Bläsius1 · Christian David Weber1 · Martin Tonglet2 · Philipp Kobbe1 · Nicole Heussen3,4 · Frank Hildebrand1 Received: 29 July 2020 / Accepted: 29 September 2020 © The Author(s) 2020
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. Keywords mTICCS · TICCS · Massive transfusion · Shock · Multiple trauma · Polytrauma · Bleeding · Transfusion · Reliability · Inter-rater reliability
* Klemens Horst [email protected]
Frank Hildebrand [email protected]
Philipp Lichte [email protected]
1
Felix Bläsius [email protected]
Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
2
Christian David Weber [email protected]
Department of Emergency, Liege University Hospital, Domaine du Sart Tilman, 4000 Liège, Belgium
3
Martin Tonglet [email protected]
Department of Medical Statistics, RWTH Aachen University, 52074 Aachen, Germany
4
Medical School, Sigmund Freud Private University, 1020 Vienna, Austria
Philipp Kobbe [email protected] Nicole Heussen [email protected]
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K. Horst et al.
Introduction As traumatic haemorrhage and ongoing bleeding are still associated with high mortality rates in patients with multiple injuries, considerable efforts have been made to predict the need for early massive transf
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