Evaluation of Head Computed Tomography Assessment of Brain Swelling after Acute Traumatic Brain Injury: A Pilot study
Arq. bras. neurocir; 38 (4), 2019
Publication year: 2019
Objective To evaluate the interobserver reliability of a new scale created for
quantitatively assessing brain swelling in traumatic brain injury (TBI) patients using
the computed tomography (CT) findings in three levels.
Methods Computed tomography scans of severe head injury patients were randomly
selected from a tertiary hospital image database and evaluated by independent groups
of neurosurgeons, neurosurgery residents, radiologists, and intensivists from the same
hospital. Each specialist assessed the tomographic findings, applying zero to six points
in a new scale. The Kappa coefficient was calculated to assess interobserver agreement.
Results The highest reliability coefficient was obtained by the neurosurgeons group
(0.791; 95% confidence interval [CI]: 0.975–0.607; p < 0.001), followed by the
neurosurgery residents group (0.402; 95%CI: 0.569–0.236; p < 0.001) and by the
radiologists group (0.301; 95%CI: 0.488–0.113; p < 0.002). The lowest coefficient was
found among the intensivists (0.248; 95%CI: 0.415–0.081; p ¼ 0.004).
Conclusion The proposed scale showed good reliability among neurosurgeons, and
moderate overall reliability. This tomographic classification might be useful to better assist
severe TBI victims, allowing to identify the worsening or amelioration of brain swelling,
which should be further investigated. The scale seems to be feasible, even in low income
countries,where the costof intracranial pressure (ICP)monitoring is higher than thatofCTs.
Lesiones Traumáticas del Encéfalo/complicaciones, Edema Encefálico/diagnóstico por imagen, Tomografía Computarizada por Rayos X/métodos, Variaciones Dependientes del Observador, Valores de Referencia, Reproducibilidad de los Resultados, Proyectos Piloto, Pronóstico, Interpretación Estadística de Datos