Variability of radiological grading of blunt cerebrovascular injuries in trauma patients
Aimee K LaRiccia1, Timothy W Wolff2, David J Magee3, Roocha Patel3, David W Hoenninger3, M Shay Oxs'Mara4, Urmil B Pandya4, Joshua H Hill4, Thanh V Nguyen4, M Chance Spalding4
1 Division of Trauma and Acute Care Surgery, Ohio Health Grant Medical Center; Department of Surgery, Ohio Health Doctors Hospital; Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
2 Division of Trauma and Acute Care Surgery, Ohio Health Grant Medical Center; Department of Surgery, Ohio Health Doctors Hospital, 3Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
3 Columbus Radiology, Columbus, OH, USA
4 Division of Trauma and Acute Care Surgery, Ohio Health Grant Medical Center; Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
Dr. Aimee K LaRiccia
Division of Trauma and Acute Care Surgery, Grant Medical Center, 111 South Grant Avenue, Columbus, OH 43215
Source of Support: None, Conflict of Interest: None
Context: Blunt cerebrovascular injury (BCVI) occurs in 1%–2% of all blunt trauma patients. Computed tomographic angiography of the neck (CTAn) is commonly used for the diagnosis and grading of BCVIs. Grade of injury dictates treatment, and there remains a lack in understanding the inter-reader reliability of these interpretations.
Aims: The aim of this study is to determine the extent of variability in BCVIs among specialized neuroradiologist interpretation of CTAn.
Settings and Design: Retrospective review of trauma patients admitted to a level one trauma center with a BCVI from January 2012 to December 2017. Patients were randomly assigned for CTAn re-evaluation by two of three blinded, neuroradiologists.
Statistical Analysis Used: The variability in BCVI grades was measured using the coefficient of unalikeability (u), and inter-reader reliability was calculated using weighted Cohen's kappa (k).
Results: Two hundred and twenty-eight BCVIs were analyzed with initial grades of 71 (31%) grade one, 74 (32%) grade two, 26 (11%) grade three, 57 (25%) grade four, and 0 grade five. Variability was present in 93 (41%) of all BCVIs. Grade one injuries had the lowest occurrence of total agreement (31%) followed by grade three (61%), grade two (63%), and grade four (92%). Total variability of grade interpretations (u = 100) occurred most frequently with grade three BCVIs (21%). Weighted Cohen's k calculations had a mean of 0.07, indicating poor reader agreement.
Conclusions: This novel study demonstrated the BCVI variability of radiological grade interpretation occurs in more than a third of patients. The reliability of CTAn interpretation of BCVI grades is not uniform, potentially leading to undertreatment and overtreatment.