Inter-Rater Reliability of Subarachnoid Hemorrhage Radiological Grading Scales: A Systematic Review and Meta-Analysis

Area of Science:

• Neurology
• Radiology
• Medical Statistics

Background:

• Subarachnoid hemorrhage (SAH) is associated with high mortality and disability rates.
• Accurate SAH severity assessment is crucial for predicting severe complications.
• Existing CT-based radiological grading systems lack comprehensive inter-rater reliability (IRR) meta-analysis.

Purpose of the Study:

• To conduct a meta-analysis of the inter-rater reliability (IRR) of CT-based radiological grading scales for subarachnoid hemorrhage (SAH).
• To assess the methodological quality of studies evaluating the IRR of SAH grading scales.

Main Methods:

• Systematic literature search of PubMed following PRISMA guidelines.
• Quality assessment of included studies using the Quality Appraisal of Reliability Studies (QAREL) tool.
• Meta-analysis of Cohen's kappa and intra-class correlation coefficient (ICC) using R packages.

Main Results:

• Twenty articles were reviewed; 14 had moderate and 5 had low methodological quality.
• Only eight studies were suitable for meta-analysis.
• The binarized Fisher scale showed a Cohen's kappa of 0.85. The Hijdra scale had an ICC of 0.75. Graeb scales (original and modified) showed ICCs of 0.83 and 0.93, respectively.

Conclusions:

• Current evidence on the IRR of radiological grading scales for SAH is limited.
• There is a significant need for high-quality research to validate the reliability and clinical utility of these scales.
• Further studies are required to improve the consistency and applicability of SAH grading systems in clinical practice.