Agreement between assessor in using shunt algorithm for frontoethmoidal encephalocele with cerebrospinal fluid circulation disorder

Introduction: Frontoethmoidal encephalocele (FEE) is a type of neural tube formation disorder. Hydrocephalus and intracranial cysts are the most common accompanying abnormalities in FEE. A high rate of shunt complications led to the development of the shunt algorithm for frontoethmoidal encephalocele (SAFE) to assess whether the shunt is needed. Method: This was a cross-sectional study with 10 cases assessed using the SAFE algorithm. Each case was assessed by two assessors in three experience groups (neurosurgical residents who have passed the neuropediatric division, chief of neurological resident, and neurosurgeon) with a double-blind sampling method. Results: The median age was ten months with 60% of the samples were female and 50% of the samples were not having shunt insertion, while 90% of the samples had FEE reconstruction. The agreement value with Fleiss Kappa showed low interrater agreement (κ = 0.037; 95% CI 0.035 to 0.039; p = 0.254) with moderate κ values of the six SAFE components where statistically significant for the cerebrospinal fluid (CSF) accumulation (κ = 0.460; 95 % CI 0.456 to 0.463; p = 0.001) and the FEE volume (κ = 0.450; 95% CI 0.447 to 0.454; p = 0.001). Agreement value in shunt insertion was adequate, with a value of κ = 0.250 (95% CI 0.245 to 0.255), p = 0.002. The agreement value in patients who had shunts was moderate with a value of κ = 0.411 (95% CI 0.403 to 0.418 p = 0.000. The agreement value in patients who were not shunted was low with a value of κ = 0.089 (95% CI 0.082 to 0.97 p = 0.439. Conclusion: The assessors’ agreement using SAFE in FEE patients with circulatory CSF abnormality was low and not statistically significant. All components did not have an optimal agreement value. The components that were closest to the moderate agreement value were the CSF accumulation and FEE volume. Both of them were statistically significant.