title: Reliability assessment of the Biffl Scale for blunt traumatic cerebrovascular injury as detected on computer tomography angiography.
abstract: OBJECTIVE Blunt traumatic cerebrovascular injury (TCVI) represents structural injury to a vessel due to high-energy trauma. The Biffl Scale is a widely accepted grading scheme for these injuries that was developed using digital subtraction angiography. In recent years, screening CT angiography (CTA) has been used to identify patients with TCVI. The reliability of this scale, with injuries assessed using CTA, has not yet been determined. METHODS Seven independent raters, including 2 neurosurgeons, 2 neuroradiologists, 2 neurosurgical residents, and 1 neurosurgical vascular fellow, independently reviewed each presenting CTA of the neck performed in 40 patients with confirmed TCVI and assigned a Biffl grade. Ten images were repeated to assess intrarater reliability, for a total of 50 CTAs. Fleiss' multirater kappa (κ) and interclass correlation were calculated as a measure of interrater reliability. Weighted Cohen's κ was used to assess intrarater reliability. RESULTS Fleiss' multirater κ was 0.65 (95% CI 0.61-0.69), indicating substantial agreement as to the Biffl grade assignment among the 7 raters. Interclass correlation was 0.82, demonstrating excellent agreement among the raters. Intrarater reliability was perfect (weighted Cohen's κ = 1) in 2 raters, and near perfect (weighted Cohen's κ > 0.8) in the remaining 5 raters. CONCLUSIONS Grading of TCVI with CTA using the Biffl Scale is reliable.
authors: Departments of 1 Neurosurgery and.
authors: Paul M
authors: PM
authors: Foreman
authors: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and.
authors: Christoph J
authors: CJ
authors: Griessenauer
authors: Departments of 1 Neurosurgery and.
authors: Kimberly P
authors: KP
authors: Kicielinski
authors: Departments of 1 Neurosurgery and.
authors: Philip G R
authors: PGR
authors: Schmalz
authors: Departments of 1 Neurosurgery and.
authors: Brandon G
authors: BG
authors: Rocque
authors: Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee.
authors: Matthew R
authors: MR
authors: Fusco
authors: Radiology, University of Alabama at Birmingham, Alabama.
authors: Joseph C
authors: JC
authors: Sullivan
authors: Departments of 1 Neurosurgery and.
authors: John P
authors: JP
authors: Deveikis
authors: Departments of 1 Neurosurgery and.
authors: Mark R
authors: MR
authors: Harrigan
mesh_terms: D020214:Cerebrovascular Trauma / Q000150:complications / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography; D006801:Humans; D015601:Injury Severity Score; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging*
keywords: Biffl Scale; Biffl grade; CA = carotid artery; CTA = CT angiography; DSA = digital subtraction angiography; ICC = interclass correlation; TCVI = traumatic cerebrovascular injury; VA = vertebral artery; dissection; interventional neurosurgery; reliability; trauma; traumatic cerebrovascular injury