The Modified Fisher Scale Lacks Interrater Reliability
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ORIGINAL WORK
The Modified Fisher Scale Lacks Interrater Reliability Christopher Melinosky1* , Hope Kincaid2, Jan Claassen3, Gunjan Parikh4, Neeraj Badjatia4 and Nicholas A. Morris4 © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background: The modified Fisher scale (mFS) is a critical clinical and research tool for risk stratification of cerebral vasospasm. As such, the mFS is included as a common data element by the National Institute of Neurological Disorders and Stroke SAH Working Group. There are few studies assessing the interrater reliability of the mFS. Methods: We distributed a survey to a convenience sample with snowball sampling of practicing neurointensivists and through the research survey portion of the Neurocritical Care Society Web site. The survey consisted of 15 scrollable CT scans of patients with SAH for mFS grading, two questions regarding the definitions of the scale criteria and demographics of the responding physician. Kendall’s coefficient of concordance was used to determine the interrater reliability of mFS grading. Results: Forty-six participants (97.8% neurocritical care fellowship trained, 78% UCNS-certified in neurocritical care, median 5 years (IQR 3–6.3) in practice, treating median of 80 patients (IQR 50–100) with SAH annually from 32 institutions) completed the survey. By mFS criteria, 30% correctly identified that there is no clear measurement of thin versus thick blood, and 42% correctly identified that blood in any ventricle is scored as “intraventricular blood.” The overall interrater reliability by Kendall’s coefficient of concordance for the mFS was moderate (W = 0.586, p
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