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161 The inter-rater agreement between the VGH and the eTHR was further assessed by calculating the kappa statistic of the ISS grouped into validated ordinal categories.
The median ISS VGH was 10 (interquartile range (IQR) 9-17.5) and the median ISS eTHR was 11 (IQR 9-18).
The Bland-Altman comparison of the ISS eTHR and ISS VGH identified the LoA to fall within -8.669-9.490.
The ICC of the individual ISSs was 0.8797 (95% CI 0.8034-0.9276), translating to excellent reliability between the ISS VGH and the ISS eTHR. The ICC of the categorical ISSs was 0.8016 (95% CI 0.6833-0.8788).
The risk estimates when using both continuous and categorical ISSs for VGH and eTHR are presented in Table 2.
The OR using the ISS VGH was 1.24 (95% CI 1.10-1.39) compared with an OR of 1.19 (95% CI 1.07-1.34) when using the ISS eTHR in the logistic regression models predicting an in-hospital complication.
Using categories for the ISS VGH in the logistic regression resulted in an OR of 5.29 (95% CI 2.01-13.98) compared with 10.85 (95% CI 3.13-37.69) when using categories for the ISS eTHR. However, both the models maintained outstanding ability to discriminate, with an ROC using the categorical ISS VGH of 0.8172 (95% CI 0.6947-0.9395) compared with an ROC of 0.8912 (95% CI 0.7967-0.9855) for the ISS eTHR, which was not significantly different (p=0.23).
The probability of adverse events is very comparable at similar VGH and eTHR ISSs.
Since the implementation of the eTHR app in our trauma centre in April 2014, front-room clinicians have entered over 15 000 patients and surgeons have coded over 3 600 ISSs, without the assistance of a single data analyst.
The ROC of the model using the ISS eTHR was no different (p=0.33), suggesting comparable predictive ability of the two sets of scores.