Interobserver Variability in the Recognition of Hypoxic-Ischemic Brain Injury on Computed Tomography Soon After Out-of-Hospital Cardiac Arrest

被引:24
作者
Caraganis, Andrew [1 ]
Mulder, Maximilian [2 ]
Kempainen, Robert R. [3 ]
Brown, Roland Z. [4 ]
Oswood, Mark [5 ]
Hoffman, Benjamin [5 ]
Prekker, Matthew E. [3 ,6 ]
机构
[1] Univ Minnesota, Div Pulm Allergy Crit Care & Sleep, MMC 276,420 Delaware St SE, Minneapolis, MN 55455 USA
[2] Abbott NW Hosp, Div Neurocrit Care, Dept Crit Care, 800 E 28th St, Minneapolis, MN USA
[3] Hennepin Cty Med Ctr, Div Pulm & Crit Care, 701 Pk Ave S, Minneapolis, MN 55415 USA
[4] Univ Minnesota, Sch Publ Hlth, Dept Biostat, 516 Delaware St SE, Minneapolis, MN USA
[5] Hennepin Cty Med Ctr, Dept Radiol, 701 Pk Ave S, Minneapolis, MN 55415 USA
[6] Hennepin Cty Med Ctr, Dept Emergency Med, 701 Pk Ave S, Minneapolis, MN 55415 USA
关键词
Out-of-hospital cardiac arrest; Neuroprognostication; Neurologic outcomes; COMATOSE PATIENTS; WHITE-MATTER; GRAY;
D O I
10.1007/s12028-019-00900-7
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background Cerebral edema and loss of gray-white matter differentiation on head computed tomography (CT) after cardiac arrest generally portend a poor prognosis. The interobserver variability in physician recognition of hypoxic-ischemic brain injury (HIBI) on early CT after out-of-hospital cardiac arrest has not been studied. Methods In this survey study, participating physicians and a neuroradiologist reviewed 20 randomly selected head CTs obtained within 2 h of out-of-hospital cardiac arrest and decided if HIBI was present. All participants were blinded to clinical details. Interobserver agreement on the presence of HIBI (primary outcome) and pairwise agreement between participants and the neuroradiologist (secondary outcome) were determined using multi- and dual-rater kappa statistics with 95% confidence intervals (CIs). Results Agreement among physicians regarding the presence of HIBI on head CT was fair (kappa 0.34; 95% CI 0.19-0.49). Individual physician agreement with the neuroradiologist varied from poor to moderate (kappa 0.0-0.48), with 8 of 10 physicians having no more than fair agreement. Regarding the perceived severity of HIBI on head CT, physician agreement was moderate (ICC = 0.56; 95% CI 0.38-0.77). Conclusion Physicians, including radiologists, demonstrated substantial interobserver variability when identifying HIBI on head CT soon after out-of-hospital cardiac arrest.
引用
收藏
页码:414 / 421
页数:8
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