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Interobserver agreement and predictive value for outcome of two rating scales for the amount of extravasated blood after aneurysmal subarachnoid haemorrhage

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Abstract

Background

In patients with SAH the amount of extravasated blood on the initial CT scan is related with delayed cerebral ischemia and clinical outcome. We investigated the interobserver variation of the Hijdra and Fisher scales for the amount of extravasated blood and the predictive values of these scales for delayed cerebral ischemia and outcome.

Methods

For 132 patients admitted within 48 hours after SAH three observers assessed the amount of blood on the initial CT scan by means of the Hijdra and Fisher scale. We analyzed interobserver agreement with kappa statistics and used multivariate logistic regression for the association with delayed cerebral ischemia and clinical outcome.

Results

The interobserver agreement of all three pairs of observers was good for the Hijdra scale (kappas for total sum scores ranging from 0.67 to 0.75) and mild to moderate for the Fisher scale (kappas ranging from 0.37 to 0.55). For the Hijdra scale the risk of DCI was higher for intermediate (OR 4.2; 95% CI 1.1–16.3) and large (OR 3.6; 95% CI 0.8–16.4) amounts of blood with small amount as reference. Fisher grade III (OR 1.0; 95% CI 0.2–5.2) and IV (OR 0.3; 95% CI 0.02–4.0) were not related with DCI. For the Hijdra scale and clinical outcome we found an increasing risk for poor outcome with intermediate (OR 3.9; 95% CI 1.0–15.9) and large (OR 10.7; 95% CI 2.3–50.1) amounts of blood. Such a relation was not found for Fisher grade III (OR 1.2; 95% CI 0.2–7.0) and IV (OR 0.2; 95% CI 0.01–3.4).

Conclusions

For the Hijdra scale we found a distinct better interobserver agreement than for the Fisher score. Moreover, the Hijdra scale was an independent prognosticator for DCI and clinical outcome, which was not the case for the Fisher score.

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Authors and Affiliations

  1. Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands

    Anouk G.W. van Norden MD, Gert W. van Dijk MD, Marc D. van Huizen MD, Ale Algra MD & Gabriël J.E. Rinkel MD

  2. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands

    Ale Algra MD

  3. Department of Neurology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands

    Anouk G.W. van Norden MD

  4. Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    Gert W. van Dijk MD

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  1. Anouk G.W. van Norden MD
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  2. Gert W. van Dijk MD
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  3. Marc D. van Huizen MD
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  4. Ale Algra MD
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  5. Gabriël J.E. Rinkel MD
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Corresponding author

Correspondence to Anouk G.W. van Norden MD.

Additional information

Received in revised form: 9 February 2006

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van Norden, A.G., van Dijk, G.W., van Huizen, M.D. et al. Interobserver agreement and predictive value for outcome of two rating scales for the amount of extravasated blood after aneurysmal subarachnoid haemorrhage. J Neurol 253, 1217–1220 (2006). https://doi.org/10.1007/s00415-006-0205-0

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  • DOI: https://doi.org/10.1007/s00415-006-0205-0

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