Interobserver agreement in the trial of org 10172 in acute stroke treatment classification of stroke based on retrospective medical record review.
Interobserver agreement in the trial of org 10172 in acute stroke treatment classification of stroke based on retrospective medical record review.
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DOI：
10.1016/j.jstrokecerebrovasdis.2006.07.001
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发表时间：
2006-11-01
期刊：
影响因子：
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通讯作者：
Worrall, Bradford B
中科院分区：
文献类型：
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作者：
Meschia, James F;Barrett, Kevin M;Worrall, Bradford B
背景：Org 10172 在中风急性中风治疗 (TOAST) 分类系统中对中风先证者兄弟姐妹进行的试验的可靠性尚未经过测试。同样，使用临床病历对缺血性中风进行分类的可靠性尚未得到评估。本研究的目的是通过将 TOAST 标准应用到回顾性获得的病历中，确定兄弟姐妹中风亚型的人际可靠性。 方法：从缺血性中风兄弟姐妹研究 (SWISS) 中风验证委员会先前分类为中风的所有兄弟姐妹的记录中随机抽取 30 份病历。这些人的盲法医疗记录被发送给 6 名医生审核员，他们根据记录审核独立对 TOAST 中风亚型进行分类。 结果：使用 kappa 统计来评估参与者间的可靠性，分配 TOAST 中风亚型的总体可靠性 (SE) 为 0.54 (0.03)。瑞士中风验证委员会最初的诊断与其他评审员做出的诊断之间的成对比较显示出中等可靠性（kappa 范围 0.41-0.56）。常见卒中亚型的 kappa 统计量为大血管，0.80 (0.06)；心源性栓塞，0.80 (0.06)；小型容器，0.53 (0.06)；未知原因，0.40 (0.06)。 结论：我们得出结论，TOAST 子类型具有中等的受试者间可靠性。大动脉和心源性栓塞亚型诊断似乎最可靠。
BACKGROUND: The reliability of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system of stroke in siblings of stroke-affected probands has not been tested. Similarly, the reliability of using clinical medical records to classify ischemic stroke has not been assessed. The purpose of this study was to establish the interrater reliability of sibling stroke subtyping by applying the TOAST criteria to retrospectively obtained medical records.METHODS: Thirty medical records were randomly sampled from among the records of all siblings previously classified as stroke affected by the Siblings with Ischemic Stroke Study (SWISS) Stroke Verification Committee. Blinded medical records for these individuals were sent to 6 physician reviewers who independently classified TOAST stroke subtype on the basis of record review.RESULTS: Using the kappa statistic to assess interrater reliability, the overall reliability (SE) for assigning a TOAST subtype of stroke was 0.54 (0.03). Pair-wise comparisons between the original SWISS Stroke Verification Committee diagnoses and the diagnoses made by other reviewers exhibited moderate reliability (kappa range 0.41-0.56). The kappa statistics for common stroke subtypes were large vessel, 0.80 (0.06); cardioembolic, 0.80 (0.06); small vessel, 0.53 (0.06); and unknown cause, 0.40 (0.06).CONCLUSION: We conclude that TOAST subtyping had moderate interrater reliability. Large-artery and cardioembolic subtype diagnoses seemed most reliable.