Statistical validity and clinical merits of a new civilian gunshot injury classification trauma

Socrates A. Brito, Zbigniew Gugala, Alai Tan, Ronald Lindsey

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Despite the high prevalence of civilian gunshot injuries (GSIs) in the United States, no universally accepted classification currently exists. Recently, two of us (ZG, RWL) proposed a GSI classification based on energy transferred, vital structure damage, wound characteristics, fracture, and degree of contamination. This classification has not been validated in a clinical setting. Questions/purposes: We determined the feasibility, internal consistency, and predictive accuracy of this classification. Methods: We reviewed the medical records of 216 patients with 264 GSIs treated at a Level I trauma center. Feasibility was determined by the investigators' ability to retrospectively complete the classification system based on patient information routinely collected in medical records. Internal consistency was determined using Cronbach's coefficient alpha. Predictive accuracy was constructed and interpreted in a receiver operating characteristic (ROC) curve using all the classification components to predict GSI severity. The clinical management/outcome (deceased, hospitalization versus nonadmission, and surgical versus nonsurgical treatment) was used as a proxy measure of GSI severity. Results: We were able to apply the classification to 82% of charts we reviewed. The classification components appeared to be internally consistent (Cronbach's alpha was 0.69 and was increased to 0.78 after exclusion of contamination). Each component was associated with clinical management. GSI classified as high energy, worse vital structure, and high contamination had higher rates of surgery (84%, 84%, and 100%, respectively). The area under the ROC curve was 0.80, suggesting the classification can accurately describe GSI severity. Conclusions: Our results suggest this new civilian GSI classification is statistically valid and has clinical merits warranting further investigation in the setting of a prospective trial. Level of Evidence: Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)3981-3987
Number of pages7
JournalClinical Orthopaedics and Related Research
Volume471
Issue number12
DOIs
StatePublished - Dec 2013

Fingerprint

Wounds and Injuries
ROC Curve
Medical Records
Trauma Centers
Proxy
Hospitalization
Research Personnel

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Statistical validity and clinical merits of a new civilian gunshot injury classification trauma. / Brito, Socrates A.; Gugala, Zbigniew; Tan, Alai; Lindsey, Ronald.

In: Clinical Orthopaedics and Related Research, Vol. 471, No. 12, 12.2013, p. 3981-3987.

Research output: Contribution to journalArticle

@article{8a2b3055e1804e7583d6e6202b0b5388,
title = "Statistical validity and clinical merits of a new civilian gunshot injury classification trauma",
abstract = "Background: Despite the high prevalence of civilian gunshot injuries (GSIs) in the United States, no universally accepted classification currently exists. Recently, two of us (ZG, RWL) proposed a GSI classification based on energy transferred, vital structure damage, wound characteristics, fracture, and degree of contamination. This classification has not been validated in a clinical setting. Questions/purposes: We determined the feasibility, internal consistency, and predictive accuracy of this classification. Methods: We reviewed the medical records of 216 patients with 264 GSIs treated at a Level I trauma center. Feasibility was determined by the investigators' ability to retrospectively complete the classification system based on patient information routinely collected in medical records. Internal consistency was determined using Cronbach's coefficient alpha. Predictive accuracy was constructed and interpreted in a receiver operating characteristic (ROC) curve using all the classification components to predict GSI severity. The clinical management/outcome (deceased, hospitalization versus nonadmission, and surgical versus nonsurgical treatment) was used as a proxy measure of GSI severity. Results: We were able to apply the classification to 82{\%} of charts we reviewed. The classification components appeared to be internally consistent (Cronbach's alpha was 0.69 and was increased to 0.78 after exclusion of contamination). Each component was associated with clinical management. GSI classified as high energy, worse vital structure, and high contamination had higher rates of surgery (84{\%}, 84{\%}, and 100{\%}, respectively). The area under the ROC curve was 0.80, suggesting the classification can accurately describe GSI severity. Conclusions: Our results suggest this new civilian GSI classification is statistically valid and has clinical merits warranting further investigation in the setting of a prospective trial. Level of Evidence: Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.",
author = "Brito, {Socrates A.} and Zbigniew Gugala and Alai Tan and Ronald Lindsey",
year = "2013",
month = "12",
doi = "10.1007/s11999-013-2953-3",
language = "English (US)",
volume = "471",
pages = "3981--3987",
journal = "Clinical Orthopaedics and Related Research",
issn = "0009-921X",
publisher = "Springer New York",
number = "12",

}

TY - JOUR

T1 - Statistical validity and clinical merits of a new civilian gunshot injury classification trauma

AU - Brito, Socrates A.

AU - Gugala, Zbigniew

AU - Tan, Alai

AU - Lindsey, Ronald

PY - 2013/12

Y1 - 2013/12

N2 - Background: Despite the high prevalence of civilian gunshot injuries (GSIs) in the United States, no universally accepted classification currently exists. Recently, two of us (ZG, RWL) proposed a GSI classification based on energy transferred, vital structure damage, wound characteristics, fracture, and degree of contamination. This classification has not been validated in a clinical setting. Questions/purposes: We determined the feasibility, internal consistency, and predictive accuracy of this classification. Methods: We reviewed the medical records of 216 patients with 264 GSIs treated at a Level I trauma center. Feasibility was determined by the investigators' ability to retrospectively complete the classification system based on patient information routinely collected in medical records. Internal consistency was determined using Cronbach's coefficient alpha. Predictive accuracy was constructed and interpreted in a receiver operating characteristic (ROC) curve using all the classification components to predict GSI severity. The clinical management/outcome (deceased, hospitalization versus nonadmission, and surgical versus nonsurgical treatment) was used as a proxy measure of GSI severity. Results: We were able to apply the classification to 82% of charts we reviewed. The classification components appeared to be internally consistent (Cronbach's alpha was 0.69 and was increased to 0.78 after exclusion of contamination). Each component was associated with clinical management. GSI classified as high energy, worse vital structure, and high contamination had higher rates of surgery (84%, 84%, and 100%, respectively). The area under the ROC curve was 0.80, suggesting the classification can accurately describe GSI severity. Conclusions: Our results suggest this new civilian GSI classification is statistically valid and has clinical merits warranting further investigation in the setting of a prospective trial. Level of Evidence: Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

AB - Background: Despite the high prevalence of civilian gunshot injuries (GSIs) in the United States, no universally accepted classification currently exists. Recently, two of us (ZG, RWL) proposed a GSI classification based on energy transferred, vital structure damage, wound characteristics, fracture, and degree of contamination. This classification has not been validated in a clinical setting. Questions/purposes: We determined the feasibility, internal consistency, and predictive accuracy of this classification. Methods: We reviewed the medical records of 216 patients with 264 GSIs treated at a Level I trauma center. Feasibility was determined by the investigators' ability to retrospectively complete the classification system based on patient information routinely collected in medical records. Internal consistency was determined using Cronbach's coefficient alpha. Predictive accuracy was constructed and interpreted in a receiver operating characteristic (ROC) curve using all the classification components to predict GSI severity. The clinical management/outcome (deceased, hospitalization versus nonadmission, and surgical versus nonsurgical treatment) was used as a proxy measure of GSI severity. Results: We were able to apply the classification to 82% of charts we reviewed. The classification components appeared to be internally consistent (Cronbach's alpha was 0.69 and was increased to 0.78 after exclusion of contamination). Each component was associated with clinical management. GSI classified as high energy, worse vital structure, and high contamination had higher rates of surgery (84%, 84%, and 100%, respectively). The area under the ROC curve was 0.80, suggesting the classification can accurately describe GSI severity. Conclusions: Our results suggest this new civilian GSI classification is statistically valid and has clinical merits warranting further investigation in the setting of a prospective trial. Level of Evidence: Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=84890427480&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890427480&partnerID=8YFLogxK

U2 - 10.1007/s11999-013-2953-3

DO - 10.1007/s11999-013-2953-3

M3 - Article

VL - 471

SP - 3981

EP - 3987

JO - Clinical Orthopaedics and Related Research

JF - Clinical Orthopaedics and Related Research

SN - 0009-921X

IS - 12

ER -