Concordancia en la detección de hemorragia subaracnoidea no traumática por medio de tomografías computarizadas de cráneo simple entre clínicos y el reporte radiológico definitivo en un hospital de 4º nivel de atención en Bogotá D.C, Colombia: 2020

Abstract

Introduction: Subarachnoid hemorrhage (SAH) consists of bleeding in the brain cavity below the arachnoid. Patients who present with SAH are admitted to the various emergency services presenting headaches in up to 25% of cases, with SAH being the cause of this headache in 1-3%. Establishing the diagnosis is important since the outcomes can be fatal. For this reason, the use of simple skull tomography (CT) has been on the rise in recent decades as an effective and rapid diagnostic method for the study of multiple acute neurological pathologies. Objective: To establish the interobserver agreement between clinical physicians and the definitive report by the radiologist on the detection of SAH within an image bank of a specific 4th level care institution in Bogota city. Method: The evaluation of the bank of computed tomography of the simple skull taken in the emergency department for non-traumatic causes was carried out in a period between January and June 2018; of these 619 images, 1.62% corresponded to HSA; 195 images were taken comparing the interpretation between clinical physicians (emergency physicians and residents of Emergency Medicine), with non-probabilistic sampling and with random selection of the evaluated simple skull tomographies. Results: The percentage according to the interpretation of the simple skull tomography for diagnosis of SAH between the clinician and the radiologist was 81.5%, with a percentage expected by chance of 55% and a Cohen's Kappa of 0.58 (CI 95% 0.71-0.46), p <0.000). In the exploratory evaluation by subgroups between emergenciologists and radiologists versus residents and radiologists, a similar behavior is observed with a Kappa of 0.59 and 0.57, respectively. Discussion: The result of this study contributes to the knowledge and tomographic interpretation of clinicians versus radiologists, one of them being subarachnoid hemorrhage, showing moderate concordance as a point of improvement, focused on offering the patient the best and most timely therapeutic conduct possible.