Christopher Melinosky1, Hope Kincaid2, Jan Claassen3, Gunjan Parikh4, Neeraj Badjatia4, Nicholas A Morris4. 1. Department of Neurology, Lehigh Valley Health Network, 1250 S Cedar Crest Blvd, Suite 405, Allentown, PA, USA. christopher.melinosky@lvhn.org. 2. Network Office of Research and Innovation (NORI), Lehigh Valley Health Network, Allentown, PA, USA. 3. Department of Neurology, Neurological Institute, New York Presbyterian Hospital, Columbia University, New York, NY, USA. 4. Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA.
Abstract
BACKGROUND: The modified Fisher scale (mFS) is a critical clinical and research tool for risk stratification of cerebral vasospasm. As such, the mFS is included as a common data element by the National Institute of Neurological Disorders and Stroke SAH Working Group. There are few studies assessing the interrater reliability of the mFS. METHODS: We distributed a survey to a convenience sample with snowball sampling of practicing neurointensivists and through the research survey portion of the Neurocritical Care Society Web site. The survey consisted of 15 scrollable CT scans of patients with SAH for mFS grading, two questions regarding the definitions of the scale criteria and demographics of the responding physician. Kendall's coefficient of concordance was used to determine the interrater reliability of mFS grading. RESULTS: Forty-six participants (97.8% neurocritical care fellowship trained, 78% UCNS-certified in neurocritical care, median 5 years (IQR 3-6.3) in practice, treating median of 80 patients (IQR 50-100) with SAH annually from 32 institutions) completed the survey. By mFS criteria, 30% correctly identified that there is no clear measurement of thin versus thick blood, and 42% correctly identified that blood in any ventricle is scored as "intraventricular blood." The overall interrater reliability by Kendall's coefficient of concordance for the mFS was moderate (W = 0.586, p < 0.0005). CONCLUSIONS: Agreement among raters in grading the mFS is only moderate. Online training tools could be developed to improve mFS reliability and standardize research in SAH.
BACKGROUND: The modified Fisher scale (mFS) is a critical clinical and research tool for risk stratification of cerebral vasospasm. As such, the mFS is included as a common data element by the National Institute of Neurological Disorders and Stroke SAH Working Group. There are few studies assessing the interrater reliability of the mFS. METHODS: We distributed a survey to a convenience sample with snowball sampling of practicing neurointensivists and through the research survey portion of the Neurocritical Care Society Web site. The survey consisted of 15 scrollable CT scans of patients with SAH for mFS grading, two questions regarding the definitions of the scale criteria and demographics of the responding physician. Kendall's coefficient of concordance was used to determine the interrater reliability of mFS grading. RESULTS: Forty-six participants (97.8% neurocritical care fellowship trained, 78% UCNS-certified in neurocritical care, median 5 years (IQR 3-6.3) in practice, treating median of 80 patients (IQR 50-100) with SAH annually from 32 institutions) completed the survey. By mFS criteria, 30% correctly identified that there is no clear measurement of thin versus thick blood, and 42% correctly identified that blood in any ventricle is scored as "intraventricular blood." The overall interrater reliability by Kendall's coefficient of concordance for the mFS was moderate (W = 0.586, p < 0.0005). CONCLUSIONS: Agreement among raters in grading the mFS is only moderate. Online training tools could be developed to improve mFS reliability and standardize research in SAH.
Authors: Gopichandh Danala; Masoom Desai; Bappaditya Ray; Morteza Heidari; Sai Kiran R Maryada; Calin I Prodan; Bin Zheng Journal: Ann Biomed Eng Date: 2022-02-02 Impact factor: 3.934
Authors: Joseph R Geraghty; Tyler J Lung; Yonatan Hirsch; Eitan A Katz; Tiffany Cheng; Neil S Saini; Dilip K Pandey; Fernando D Testai Journal: Neurosurgery Date: 2021-11-18 Impact factor: 5.315
Authors: Zheng-Yii Lee; Cindy Sing Ling Yap; M Shahnaz Hasan; Julia Patrick Engkasan; Mohd Yusof Barakatun-Nisak; Andrew G Day; Jayshil J Patel; Daren K Heyland Journal: Crit Care Date: 2021-07-23 Impact factor: 9.097