Analysis of interobserver disagreement in the assessment of subarachnoid blood and acute hydrocephalus on CT scans

Neurol Res. 1996 Dec;18(6):487-94. doi: 10.1080/01616412.1996.11740459.

Abstract

The purpose of this study was to analyse factors for interobserver disagreements in two scales used for the assessments of the amount of blood in subarachnoid space (Fisher grading) and of acute hydrocephalus on computerized tomographic (CT) scans. The assessments made by four neuroradiologists on 59 CT scans obtained in the acute stage after subarachnoid hemorrhage were analysed by a statistical method by Svensson and Holm. This method permits the separation of the inter-observer disagreements in their random and systematic components. The overall consistency of the assessments was significant (p < 0.0005) but the neuroradiologists disagreed on half of the CT-scans. The kappa values were 0.50-0.63. The analysis showed that the main reason for disagreements was systematic inter-observer differences in their use of the clinically most important parts of staging, i.e. subarachnoid clot or intraventricular blood (Fisher grading) and too low categories (hydrocephalus). The main conclusion from this study is that the proper remedy for Fisher grading and for grading of hydrocephalus is a sharpening of the criteria of specific category levels and given this improvement both grading systems will show a high level of reliability.

MeSH terms

  • Data Interpretation, Statistical
  • Humans
  • Hydrocephalus / diagnostic imaging
  • Hydrocephalus / epidemiology*
  • Observer Variation
  • Radiology / standards*
  • Radiology / statistics & numerical data
  • Reproducibility of Results
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Subarachnoid Hemorrhage / epidemiology*
  • Tomography, X-Ray Computed / statistics & numerical data*