• World Neurosurg · Jul 2021

    Modified Computed Tomography Classification for Chronic Subdural Hematoma Features Good Inter-Rater Agreement: A Single-Center Retrospective Cohort Study.

    • Jun Takei, Tatsuya Hirotsu, Keisuke Hatano, Toshihiro Ishibashi, Takayuki Inomata, Yasuto Noda, Satoru Morooka, and Yuichi Murayama.
    • Department of Neurosurgery, Fuji City General Hospital, Fuji, Shizuoka, Japan; Department of Neurosurgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan. Electronic address: j_tki@jikei.ac.jp.
    • World Neurosurg. 2021 Jul 1; 151: e407-e417.

    ObjectiveThe present study aimed to establish whether our modified Nakaguchi computed tomography (CT) classification improves the interrater agreement of chronic subdural hematoma (CSDH) classification and prediction of CSDH recurrence relative to 2 other CT classifications.MethodsThis retrospective study considered 277 consecutive patients with CSDH and 307 hematomas treated with burr-hole surgery between January 2009 and December 2018. Two neurosurgeons blinded to patients' clinical data classified the CT scans of patients with CSDH into 4 or 5 types according to the Nomura classification (high, iso, low, mixed, and layering), Nakaguchi classification (homogenous, laminar, separated, and trabecular), and our modified Nakaguchi classification (homogenous, gradation, laminar, separated, and trabecular). The κ statistic was used to evaluate the interrater agreement of the 3 CT classifications. Univariable and multivariable logistic regression analyses were used to calculate odds ratios for CSDH recurrence.Resultsκ values of the modified, Nakaguchi, and Nomura classification were 0.78, 0.63, and 0.70, respectively. During the 3 months follow-up, the recurrence rate for CSDH was 11.4% (35/307 hematomas). Of the types defined by the modified classification, the gradation type was associated with the highest recurrence (mean recurrence rate, 15.9% ± 0.3%). Multivariable logistic regression analyses showed that a gradation-type hematoma, as defined with the modified classification, was an independent risk factor associated with recurrence (odds ratio, 2.36; 95% confidence interval, 1.11-4.98; P = 0.025).ConclusionsThe modified classification was useful for preoperative CT classification of CSDH and the prediction of recurrence, with high agreement between raters.Copyright © 2021 Elsevier Inc. All rights reserved.

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