Evaluation of Head Computed Tomography Assessment of Brain Swelling after Acute Traumatic Brain Injury: A Pilot study

Abstract

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 = 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 cost of intracranial pressure (ICP) monitoring is higher than that of CTs.

Resumo

Objetivo Avaliar a confiabilidade interobservador de uma nova escala criada para avaliar quantitativamente o edema cerebral em pacientes com trauma cranioencefálico (TCE) utilizando os achados de tomografia computadorizada (TC) em três níveis.

Métodos Tomografias computadorizadas de pacientes com TCE grave foram selecionadas aleatoriamente a partir de um banco de imagens de hospitais terciários e avaliadas por grupos independentes de neurocirurgiões, residentes de neurocirurgia, radiologistas e intensivistas do mesmo hospital. Cada especialista avaliou os achados tomográficos, aplicando zero a seis pontos em uma nova escala. O coeficiente Kappa foi calculado para avaliar a concordância interobservador.

Resultados O maior coeficiente de confiabilidade foi obtido pelo grupo de neurocirurgiões (0,791, intervalo de confiança [IC] de 95%: 0,975–0,607; p < 0,001), seguido pelo grupo de residentes de neurocirurgia (0,402; IC95%: 0,569–0,236; p < 0,001) e o grupo de radiologistas (0,301; IC 95% 0,488–0,113; p < 0,002). O menor coeficiente foi encontrado entre os intensivistas (0,248; IC95%: 0,415–0,081; p = 0,004).

Conclusão A escala proposta mostrou boa confiabilidade entre os neurocirurgiões e moderada confiabilidade geral. Essa classificação tomográfica pode ser útil para auxiliar melhor as vítimas graves de TCE, permitindo identificar o agravamento ou melhoria do inchaço cerebral, que deve ser mais investigado. A escala parece ser viável, mesmo em países de baixa renda, onde o custo da monitoração da pressão intracraniana (PIC) é maior que o dos TCs.

Keywords

brain injurytraumatic - tomography - critical care - prognosis

Palavras-chave

lesão cerebral - traumática - tomografia - tratamento crítico - prognóstico

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