Department of Radiology, Stanford University, Stanford, California, USA.
Department of Medicine, Stanford University, Stanford, California, USA.
J Neurotrauma. 2020 Jun 15;37(12):1445-1451. doi: 10.1089/neu.2019.6871. Epub 2020 Mar 11.
The purpose of this study was to determine the interobserver variability among providers of different specialties and levels of experience across five established computed tomography (CT) scoring systems for acute traumatic brain injury (TBI). One hundred cases were selected at random from a retrospective population of adult patients transported to our emergency department and subjected to a non-contrast head CT due to suspicion of TBI. Eight neuroradiologists and neurosurgeons in trainee (residents and fellows) and attending roles independently scored each non-contrast head CT scan on the Marshall, Rotterdam, Helsinki, Stockholm, and NeuroImaging Radiological Interpretation System (NIRIS) head CT scales. Interobserver variability of scale scores-overall and by specialty and level of training-was quantified using the intraclass correlation coefficient (ICC), and agreement with respect to National Institutes of Health Common Data Elements (NIH CDEs) was assessed using Cohen's kappa. All CT severity scoring systems showed high interobserver agreement as evidenced by high ICCs, ranging from 0.75-0.89. For all scoring systems, neuroradiologists (ICC range from 0.81-0.94) tended to have higher interobserver agreement than neurosurgeons (ICC range from 0.63-0.76). For all scoring systems, attendings (ICC range from 0.76-0.89) had similar interobserver agreement to trainees (ICC range from 0.73-0.89). Agreement with respect to NIH CDEs was high for ascertaining presence/absence of hemorrhage, skull fracture, and mass effect, with estimated kappa statistics of least 0.89. Acute TBI CT scoring systems demonstrate high interobserver agreement. These results provide scientific rigor for future use of these systems for the classification of acute TBI.
本研究旨在确定不同专业和经验水平的提供者在五个已建立的急性创伤性脑损伤（TBI）计算机断层扫描（CT）评分系统中的观察者间变异性。从我们急诊部因疑似 TBI 而接受非对比头部 CT 的成年患者的回顾性人群中随机选择了 100 例。8 名神经放射科医生和神经外科医生以受训者（住院医师和研究员）和主治医生的身份独立对每个非对比头部 CT 扫描进行评分，使用 Marshall、Rotterdam、Helsinki、Stockholm 和神经影像学放射学解释系统（NIRIS）头部 CT 量表。使用组内相关系数（ICC）量化了量表评分的观察者间变异性（总体和按专业和培训水平），并使用 NIH 常见数据元素（NIH CDE）评估了与 Cohen's kappa 的一致性。所有 CT 严重程度评分系统均显示出高度的观察者间一致性，ICC 较高，范围为 0.75-0.89。对于所有评分系统，神经放射科医生（ICC 范围为 0.81-0.94）的观察者间一致性高于神经外科医生（ICC 范围为 0.63-0.76）。对于所有评分系统，主治医生（ICC 范围为 0.76-0.89）与受训者（ICC 范围为 0.73-0.89）的观察者间一致性相似。对于确定是否存在出血、颅骨骨折和肿块效应，NIH CDE 的一致性较高，估计kappa 统计量至少为 0.89。急性 TBI CT 评分系统显示出高度的观察者间一致性。这些结果为未来使用这些系统对急性 TBI 进行分类提供了科学依据。
