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Related Experiment Videos

Observer variability in grading patients with subarachnoid hemorrhage

K W Lindsay, G Teasdale, R P Knill-Jones

    Journal of Neurosurgery
    |May 1, 1982
    PubMed
    Summary

    Current subarachnoid hemorrhage grading systems show significant observer variability, complicating patient management. A simpler, more reliable system is needed for consistent clinical assessment.

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    Area of Science:

    • Neurology
    • Clinical Assessment
    • Medical Grading Systems

    Background:

    • Subarachnoid hemorrhage management relies on clinical assessment.
    • Current grading systems (Hunt and Hess, Nishioka) exhibit application difficulties.

    Observation:

    • Observers showed considerable variability when grading 15 subarachnoid hemorrhage patients.
    • Most variation occurred with Grade 3, irrespective of the system used.
    • Inconsistency stemmed from matching patients to system descriptions, not examination technique.

    Findings:

    • Kappa statistics revealed observer agreement was better than chance but marked variation persisted.
    • Variability increased for patients with systemic disease or vasospasm using the Hunt and Hess system.
    • Inconsistent grading was primarily due to subjective interpretation of clinical summaries.

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    Implications:

    • A simpler, more reliable grading system for subarachnoid hemorrhage is essential.
    • Caution is advised when comparing results across different published studies.
    • Standardizing clinical assessment is crucial for accurate patient stratification and treatment planning.