title: Interobserver variability of grading scales for aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Worldwide, different scales are used to assess the clinical condition on admission after aneurysmal subarachnoid hemorrhage. In addition to the prognostic value, the inter-rater variability should be taken into account when deciding which scale preferably should be used. We assessed the interobserver agreement of the commonly used World Federation of Neurological Surgeons, the Hunt and Hess, and the Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage scales.
  
  
  METHODS
  In a cohort of 50 subarachnoid hemorrhage patients, 103 paired assessments were performed on the 3 admission scales by 2 independent observers per assessment with a total of 57 different raters. Patients were assessed during the first week after the hemorrhage. The interobserver agreement was calculated using quadratic (weighted) kappa statistics.
  
  
  RESULTS
  The weighted kappa value of the Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage scale was 0.64 (95% CI, 0.49-0.79), of the World Federation of Neurological Surgeons scale was 0.60 (95% CI, 0.48-0.73), and of the Hunt and Hess scale was 0.48 (95% CI, 0.36-0.59).
  
  
  CONCLUSIONS
  The Hunt and Hess scale showed the lowest interobserver agreement, whereas agreement of the World Federation of Neurological Surgeons and Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage scales was similar with overlapping CI.
authors.affiliation: University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Lieveke A R
authors.initials: LA
authors.lastname: Degen
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Dorhout Mees
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Gabriël J E
authors.initials: GJ
authors.lastname: Rinkel
mesh_terms: D000328:Adult; D000368:Aged; D003943:Diagnostic Techniques, Neurological / Q000592:standards*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D011379:Prognosis; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000473:pathology*; D055815:Young Adult