Interobserver Variability in the Recognition of Hypoxic–Ischemic Brain Injury on Computed Tomography Soon After Out-of-Hospital Cardiac Arrest

Andrew Caraganis, Maximilian Mulder, Robert R. Kempainen, Roland Z. Brown, Mark Oswood, Benjamin Hoffman, Matthew E. Prekker

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Cerebral edema and loss of gray–white matter differentiation on head computed tomography (CT) after cardiac arrest generally portend a poor prognosis. The interobserver variability in physician recognition of hypoxic–ischemic brain injury (HIBI) on early CT after out-of-hospital cardiac arrest has not been studied. Methods: In this survey study, participating physicians and a neuroradiologist reviewed 20 randomly selected head CTs obtained within 2 h of out-of-hospital cardiac arrest and decided if HIBI was present. All participants were blinded to clinical details. Interobserver agreement on the presence of HIBI (primary outcome) and pairwise agreement between participants and the neuroradiologist (secondary outcome) were determined using multi- and dual-rater kappa statistics with 95% confidence intervals (CIs). Results: Agreement among physicians regarding the presence of HIBI on head CT was fair (kappa 0.34; 95% CI 0.19–0.49). Individual physician agreement with the neuroradiologist varied from poor to moderate (kappa 0.0–0.48), with 8 of 10 physicians having no more than fair agreement. Regarding the perceived severity of HIBI on head CT, physician agreement was moderate (ICC = 0.56; 95% CI 0.38–0.77). Conclusion: Physicians, including radiologists, demonstrated substantial interobserver variability when identifying HIBI on head CT soon after out-of-hospital cardiac arrest.

Original languageEnglish (US)
Pages (from-to)414-421
Number of pages8
JournalNeurocritical Care
Issue number2
StatePublished - Oct 1 2020

Bibliographical note

Funding Information:
We?d like to thank Dr. Eileen Harwood for feedback on our online survey. In addition, we are grateful for statistical support provided by the University of Minnesota Biostatistical Design and Analysis Center.

Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.


  • Neurologic outcomes
  • Neuroprognostication
  • Out-of-hospital cardiac arrest


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