Pe. Vos et al., Evaluation of the traumatic coma data bank computed tomography classification for severe head injury, J NEUROTRAU, 18(7), 2001, pp. 649-655
This study determines the interrater and intrarater reliability of the Trau
matic Coma Data Bank (TCDB) computed tomography (CT) scan classification fo
r severe head injury. This classification grades the severity of the injury
as follows: I = normal, II = diffuse injury, III = diffuse injury with swe
lling, IV = diffuse injury with shift, V = mass lesion surgically evacuated
, or VI = mass lesion not operated. Patients with severe closed head injury
were included. Outcome was assessed using the Glasgow Outcome Score (GOS)
at 3 and 6 months. Four observers, two of them classifying the scans twice,
independently evaluated CT scans. Of the initial CT scans of 63 patients (
36 males, 27 females; age, 34 +/- 24 years), 6.3% were class I, 26.9% class
II, 28.6% class III, 6.3% class IV, 22.2% were class V, and 9.6% class VI.
The overall interrater and intrarater reliability was 0.80 and 0.85, respe
ctively. Separate analyses resulted in higher inter- and intrarater reliabi
lities for the mass lesion categories (V and VI), 0.94 and 0.91, respective
ly, than the diffuse categories (I-IV) 0.71 and 0.67. Merging category III
with IV, and V with VI resulted in inter- and intrarater reliabilities of 0
.93 and 0.78, respectively. Glasgow outcome scores after 6 months were as f
ollows: 19 dead (30%), one vegetative (2%), five severely disabled (8%), 17
moderately disabled (27%), and 21 good recovery (33%). Association measure
s (Sommers' D) between CT and GOS scores were statistically significant for
all observers. This study shows a high intra- and interobserver agreement
in the assessment of CT scan abnormalities and confirms the predictive powe
r on outcome when the TCDB classification is used.