CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2019; 38(04): 257-262
DOI: 10.1055/s-0039-1698785
Original Article | Artigo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

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

Avaliação da tomografia computadorizada de crânio com edema cerebral após lesão cerebral traumática aguda: Um estudo piloto
Robson Luis Amorim
1   Division of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Barbara Albuquerque Morais
1   Division of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Francisco Otávio Camargo Pereira
2   Division of Neurosurgery, Universidade do Estado de São Paulo, Botucatu, SP, Brazil
,
1   Division of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Almir Ferreira Andrade
1   Division of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Edson Bor-Seng-Shu
1   Division of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Marcelo Lima Oliveira
1   Division of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Manoel Jacobsen Teixeira
1   Division of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Wellingson Silva Paiva
1   Division of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

12 May 2019

06 August 2019

Publication Date:
31 October 2019 (online)

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.

 
  • References

  • 1 Raj R, Skrifvars M, Bendel S. , et al. Predicting six-month mortality of patients with traumatic brain injury: usefulness of common intensive care severity scores. Crit Care 2014; 18 (02) R60
  • 2 Kraus JF. Epidemiology of Head Injury. In: Cooper Paul R. ., editor. Head Injury. Williams and Wilkins; 1993
  • 3 Sosin DM, Sniezek JE, Waxweiler RJ. Trends in death associated with traumatic brain injury, 1979 through 1992. Success and failure. JAMA 1995; 273 (22) 1778-1780
  • 4 Unterberg AW, Stover J, Kress B, Kiening KL. Edema and brain trauma. Neuroscience 2004; 129 (04) 1021-1029
  • 5 Zimmerman RA, Bilaniuk LT, Genneralli T. Computed tomography of shearing injuries of the cerebral white matter. Radiology 1978; 127 (02) 393-396
  • 6 Zimmerman RA, Bilaniuk LT, Bruce D, Dolinskas C, Obrist W, Kuhl D. Computed tomography of pediatric head trauma: acute general cerebral swelling. Radiology 1978; 126 (02) 403-408
  • 7 Liu H, Wang W, Cheng F, Yuan Q. , et al: External ventricular drains versus intraparenchymal intracranial pressure monitors in traumatic brain injury: a prospective observational study. World Neurosurgery 2014 Dec 23. pii: S1878–8750(14)01411–9.
  • 8 Chesnut RM, Temkin N, Carney N. , et al; Global Neurotrauma Research Group. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012; 367 (26) 2471-2481
  • 9 Marshall LF, Marshall SB, Klauber MR. , et al. A new classification of head injury based on computerized tomography. J Neurotrauma 1992; 9 (Suppl. 01) S287-S292
  • 10 Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery 2005; 57 (06) 1173-1182 , discussion 1173–1182
  • 11 Marshall LF, Marshall SB, Klauber MR. , et al. The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 1992; 9 (Suppl. 01) S287-S292
  • 12 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (01) 159-174
  • 13 Majdan M, Lingsma HF, Nieboer D, Mauritz W, Rusnak M, Steyerberg EW. Performance of IMPACT, CRASH and Nijmegen models in predicting six month outcome of patients with severe or moderate TBI: an external validation study. Scand J Trauma Resusc Emerg Med 2014; 22: 68
  • 14 Mata-Mbemba D, Mugikura S, Nakagawa A. , et al. Early CT findings to predict early death in patients with traumatic brain injury: Marshall and Rotterdam CT scoring systems compared in the major academic tertiary care hospital in northeastern Japan. Acad Radiol 2014; 21 (05) 605-611
  • 15 Maas AI, Steyerberg EW, Butcher I. , et al. Prognostic value of computerized tomography scan characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007; 24 (02) 303-314
  • 16 Kesinger MR, Nagy LR, Sequeira DJ, Charry JD, Puyana JC, Rubiano AM. A standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country. Injury 2014; 45 (09) 1350-1354