Evaluating inter-and intra-rater reliability in the bronchoscopic grading of burn inhalation injury: The iBRONCH-BII study

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BACKGROUND: The evidence that the severity of burn inhalation injury (BII) impacts clinical outcomes is inconsistent. This may be due to misclassification arising from the subjectivity in bronchoscopically grading BII using systems such as the Abbreviated Injury Score (AIS). This study aimed to evaluate inter- and intra-rater reliability in the grading of BII using the AIS. METHODOLOGY: In a cohort study, specialist burns clinicians (n = 17) and novices (n = 10) graded sixteen BII bronchoscopic images using the AIS during an online meeting. Inter-rater reliability was evaluated using the Kappa statistic (k), with values < 0.60 considered clinically inadequate. The grade rating process was repeated after seven days to evaluate intra-rater reliability. Evaluation of reliability in the grading of BII bronchoscopy reports was conducted as a sensitivity analysis. RESULTS: Amongst all raters, inter-rater reliability was low for grading images (k = 0.30, 95 % confidence interval (CI): 0.29-0.31). Intra-rater reliability was higher than inter-rater reliability, but was still low, with median image grade rate k = 0.45 (interquartile range [IQR]:0.24-0.53). Intensivists demonstrated the highest rater reliability. CONCLUSION: Reliability in rating the grade of BII by bronchoscopic images was clinically inadequate. Strategies to improve the reliability of reporting the grade of BII are required.

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