Gong Kai, Shi Tao, Zhao Lizheng, Xu Zhong, Wang Zhanxiang
Department of Neurosurgery, The First Affiliated Hospital of Xia'men University, Xia'men, Fujian, China.
Department of Rehabilitation, Xia'men Humanity Rehabilitation Hospital, Xia'men, Fujian, China.
Clin Neurol Neurosurg. 2021 May 1;205:106668. doi: 10.1016/j.clineuro.2021.106668.
To compare the inter-observer reliability among neurosurgeons while estimating the intracerebral haematoma (ICH) volume by the Tada formula and assess its influence on predicting the severity and prognosis of various ICHs.
We obtained clinical data from 262 consecutive patients with spontaneous ICH. The haematoma volume was independently calculated and compared by 3D Slicer and eight neurosurgeons. The inter-observer reliability was obtained by calculating the intraclass correlation coefficients (ICC) and Cohen's kappa score (kappa), within different shape and volume ICH subgroups. We conducted the receiver operating characteristic analysis to assess the predictive value of the ICH volume evaluated for clinical features, including the Glasgow Coma Scale at the onset of the disease, ICH-related surgical treatments, the length of stay in the intensive care unit, the length of hospitalisation, the modified Rankin Scale score at discharge, and in-hospital deaths.
The median haematoma volume was 17.4 ml (range, 7.3-34.7 ml). The estimated volumes were significantly different among neurosurgeons (p < 0.001). Six out of eight neurosurgeons demonstrated obvious deviations from the 3D Slicer software (p < 0.001). Round (ICC: 0.947) and tapered (ICC: 0.954) haematomas were more consistently evaluated between the neurosurgeons. We observed a substantial strength of agreement between neurosurgeons with kappa> 0.693 and ICC: 0.938 in the entire volume range, and slight to fair strength of agreement with kappa> 0.175 and ICC: 0.689 between 20 ml and 40 ml volume interval. All estimated volumes had a positive predictive value for clinical features, with the area under the curve > 0.5 (p < 0.05). However, the 3D Slicer software performed relatively better than most neurosurgeons.
There exists a significant inter-observer variability among neurosurgeons when utilizing the Tada formula, thus demonstrating significant implications for ICH-related clinical practices and researches.
比较神经外科医生使用田田公式估算脑内血肿（ICH）体积时的观察者间可靠性，并评估其对预测各种ICH严重程度和预后的影响。
我们收集了262例连续自发性ICH患者的临床资料。血肿体积由3D Slicer软件和八位神经外科医生独立计算并进行比较。通过计算不同形状和体积ICH亚组内的组内相关系数（ICC）和科恩kappa评分（kappa）来获得观察者间可靠性。我们进行了受试者操作特征分析，以评估评估的ICH体积对临床特征的预测价值，包括疾病发作时的格拉斯哥昏迷量表、ICH相关手术治疗、重症监护病房住院时间、住院时间、出院时改良Rankin量表评分以及院内死亡情况。
血肿体积中位数为17.4 ml（范围7.3 - 34.7 ml）。神经外科医生之间估计的体积存在显著差异（p < 0.001）。八位神经外科医生中有六位与3D Slicer软件显示出明显偏差（p < 0.001）。圆形（ICC：0.947）和锥形（ICC：0.954）血肿在神经外科医生之间的评估更为一致。我们观察到在整个体积范围内，kappa > 0.693且ICC：0.938时神经外科医生之间有很强的一致性，在20 ml至40 ml体积区间内，kappa > 0.175且ICC：0.689时有轻微至中等程度的一致性。所有估计体积对临床特征均具有阳性预测价值，曲线下面积> 0.5（p < 0.05）。然而，3D Slicer软件的表现相对优于大多数神经外科医生。
神经外科医生在使用田田公式时存在显著的观察者间变异性，这对ICH相关的临床实践和研究具有重要意义。
