Imperial Neurotrauma Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
NIHR Imperial Biomedical Research Centre, Imperial College, The Bays, 2 South Wharf Road, London, UK.
Br J Neurosurg. 2022 Oct;36(5):633-638. doi: 10.1080/02688697.2022.2090509. Epub 2022 Jun 30.
The measurement of traumatic brain injury (TBI) 'severity' has traditionally been based on the earliest Glasgow Coma Score (GCS) recorded, however, the underlying parenchymal pathology is highly heterogonous. This heterogeneity renders prediction of outcome on an individual patient level inaccurate and makes comparison between patients both in clinical practice and research difficult. The complexity of this heterogeneity has resulted in generic all encompassing 'traumatic brain injury protocols'. Early management and studies of neuro-protectants are often done irrespective of TBI type, yet it may well be that a specific treatment may be beneficial in a subset of TBI pathologies.
A simple CT-based classification system rating the recognised types of blunt TBI (extradural, subdural, subarachnoid haemorrhage, contusions/intracerebral haematoma and diffuse axonal injury) as mild (1), moderate (2) or severe (3) is proposed. Hypoxic brain injury, a common secondary injury following TBI, is also included. Scores can be combined to reflect concomitant types of TBI and predominant location of injury is also recorded. To assess interrater reliability, 50 patient CT images were assessed by 5 independent clinicians of varying experience. Interrater reliability was calculated using overall agreement through Cronbach's alpha including confidence intervals for intra-class coefficients.
Interrater reliability scores showed strong agreement for same score and same injury for TBIs with blood on CT and Cronbach's alpha co-efficient (range 0.87-0.93) demonstrated excellent correlation between raters. Cronbach's alpha was not affected when individual raters were removed.
The proposed simple CT classification system has good inter-rater reliability and hence potentially could enable better individual prognostication and targeted treatments to be compared while also accounting for multiple intracranial injury types. Further studies are proposed and underway.
传统上，创伤性脑损伤（TBI）“严重程度”的测量基于记录的最早格拉斯哥昏迷评分（GCS），然而，潜在的实质病理学高度异质。这种异质性使得在个体患者水平上预测结果不准确，并使得在临床实践和研究中比较患者变得困难。这种异质性的复杂性导致了通用的包罗万象的“创伤性脑损伤方案”。早期管理和神经保护剂的研究通常都不考虑 TBI 类型，但很可能特定的治疗方法在某些 TBI 病理类型中可能是有益的。
提出了一种基于 CT 的简单分类系统，对公认的几种钝性 TBI 类型（硬膜外血肿、硬膜下血肿、蛛网膜下腔出血、脑挫裂伤/脑内血肿和弥漫性轴索损伤）进行轻度（1）、中度（2）或重度（3）分类。TBI 后常见的继发性缺氧性脑损伤也包括在内。可以组合分数以反映同时存在的 TBI 类型，并记录损伤的主要部位。为了评估组内一致性，由 5 名经验不同的独立临床医生评估了 50 名患者的 CT 图像。使用 Cronbach 的 alpha 包括组内系数的置信区间，通过总体一致性计算组内一致性。
对于 CT 上有血液的 TBI，评分相同和损伤相同的情况下，评分者之间的一致性评分较高，Cronbach 的 alpha 系数（范围为 0.87-0.93）显示出评分者之间的良好相关性。当个别评分者被剔除时，Cronbach 的 alpha 不受影响。
提出的简单 CT 分类系统具有良好的组内一致性，因此有可能能够更好地进行个体预后预测和靶向治疗比较，同时考虑多种颅内损伤类型。进一步的研究正在进行中。
