Development and validation of the injury severity assessment survey/parent report: a new injury severity assessment survey

OBJECTIVE: To develop and pilot test a telephone-based survey instrument that enables parents to identify and characterize the body region and severity of childhood injuries using the Abbreviated Injury Scale (AIS) scoring system. DESIGN: A prospective cross-sectional survey. SETTING: The emergency department of an urban, tertiary care, pediatric trauma center. PARTICIPANTS: One hundred forty-seven parents of children younger than 18 years and seen in the emergency department for acute treatment of an unintentional injury. INTERVENTIONS: None. MAIN OUTCOME MEASURE: The degree of agreement, measured as sensitivity, specificity, and kappa statistic, between medical record information and parents' responses to the telephone survey regarding the identification and characterization of clinically significant (AIS > or =2) injuries. RESULTS: The survey, known as the Injury Severity Assessment Survey/Parent Report, was developed via a systematic review of the AIS 1990 manual. Answers to questions were developed in a way that enabled automated coding of responses into AIS scores or ranges of scores. The sensitivity of the survey (its ability to detect injuries scoring 2 or more on the AIS that were documented in the medical record) varied somewhat by the body region of injury, ranging from 88% for head, face, neck, and spine injuries to 95% for extremity injuries. Intermediate sensitivity (92%) was noted for the detection of significant chest and abdomen injuries. The specificity of the survey (its ability to rule out the presence of a significant injury when one was not documented in the medical record) was more than 95% in each of the 3 body region groups. The kappa statistics for the 3 body region groups ranged from 0.89 to 0.92. CONCLUSIONS: A new telephone-based survey has been developed that enables parents to characterize their child's injuries by body region and to differentiate between minor injuries and more significant injuries using a well-established injury classification system. This survey has a significant advantage over previous telephone-based or written surveys of childhood injuries and may be particularly valuable in population-based (e.g., random-digit dial surveys) or multi-institutional studies of pediatric injuries.