Abstract
Background: A reliable and reproducible classification system of stroke subtype is essential for epidemiological and genetic studies. The Causative Classification of Stroke system is an evidence-based computerized algorithm with excellent inter-rater reliability. It has been suggested that, compared to the Trial of ORG 10172 in Acute Stroke Treatment classification, it increases the proportion of cases with defined subtype that may increase power in genetic association studies. We compared Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications in a large cohort of well-phenotyped stroke patients. Methods: Six hundred ninety consecutively recruited patients with first-ever ischemic stroke were classified, using review of clinical data and original imaging, according to the Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications. Results: There was excellent agreement subtype assigned by between Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system (kappa=0·85). The agreement was excellent for the major individual subtypes: large artery atherosclerosis kappa=0·888, small-artery occlusion kappa=0·869, cardiac embolism kappa=0·89, and undetermined category kappa=0·884. There was only moderate agreement (kappa=0·41) for the subjects with at least two competing underlying mechanism. Thirty-five (5·8%) patients classified as undetermined by Trial of ORG 10172 in Acute Stroke Treatment were assigned to a definite subtype by Causative Classification of Stroke system. Thirty-two subjects assigned to a definite subtype by Trial of ORG 10172 in Acute Stroke Treatment were classified as undetermined by Causative Classification of Stroke system. Conclusions: There is excellent agreement between classification using Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke systems but no evidence that Causative Classification of Stroke system reduced the proportion of patients classified to undetermined subtypes. The excellent inter-rater reproducibility and web-based semiautomated nature make Causative Classification of Stroke system suitable for multicenter studies, but the benefit of reclassifying cases already classified using the Trial of ORG 10172 in Acute Stroke Treatment system on existing databases is likely to be small.
| Original language | English |
|---|---|
| Pages (from-to) | 626-631 |
| Number of pages | 6 |
| Journal | International Journal of Stroke |
| Volume | 8 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - 2013 |
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Keywords
- Genetics disorders
- Risk factors
- Stroke subtypes
ASJC Scopus subject areas
- Neurology
Cite this
Stroke subtyping for genetic association studies? A comparison of the CCS and TOAST classifications. / Lanfranconi, Silvia; Markus, Hugh S.
In: International Journal of Stroke, Vol. 8, No. 8, 2013, p. 626-631.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Stroke subtyping for genetic association studies? A comparison of the CCS and TOAST classifications
AU - Lanfranconi, Silvia
AU - Markus, Hugh S.
PY - 2013
Y1 - 2013
N2 - Background: A reliable and reproducible classification system of stroke subtype is essential for epidemiological and genetic studies. The Causative Classification of Stroke system is an evidence-based computerized algorithm with excellent inter-rater reliability. It has been suggested that, compared to the Trial of ORG 10172 in Acute Stroke Treatment classification, it increases the proportion of cases with defined subtype that may increase power in genetic association studies. We compared Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications in a large cohort of well-phenotyped stroke patients. Methods: Six hundred ninety consecutively recruited patients with first-ever ischemic stroke were classified, using review of clinical data and original imaging, according to the Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications. Results: There was excellent agreement subtype assigned by between Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system (kappa=0·85). The agreement was excellent for the major individual subtypes: large artery atherosclerosis kappa=0·888, small-artery occlusion kappa=0·869, cardiac embolism kappa=0·89, and undetermined category kappa=0·884. There was only moderate agreement (kappa=0·41) for the subjects with at least two competing underlying mechanism. Thirty-five (5·8%) patients classified as undetermined by Trial of ORG 10172 in Acute Stroke Treatment were assigned to a definite subtype by Causative Classification of Stroke system. Thirty-two subjects assigned to a definite subtype by Trial of ORG 10172 in Acute Stroke Treatment were classified as undetermined by Causative Classification of Stroke system. Conclusions: There is excellent agreement between classification using Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke systems but no evidence that Causative Classification of Stroke system reduced the proportion of patients classified to undetermined subtypes. The excellent inter-rater reproducibility and web-based semiautomated nature make Causative Classification of Stroke system suitable for multicenter studies, but the benefit of reclassifying cases already classified using the Trial of ORG 10172 in Acute Stroke Treatment system on existing databases is likely to be small.
AB - Background: A reliable and reproducible classification system of stroke subtype is essential for epidemiological and genetic studies. The Causative Classification of Stroke system is an evidence-based computerized algorithm with excellent inter-rater reliability. It has been suggested that, compared to the Trial of ORG 10172 in Acute Stroke Treatment classification, it increases the proportion of cases with defined subtype that may increase power in genetic association studies. We compared Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications in a large cohort of well-phenotyped stroke patients. Methods: Six hundred ninety consecutively recruited patients with first-ever ischemic stroke were classified, using review of clinical data and original imaging, according to the Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications. Results: There was excellent agreement subtype assigned by between Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system (kappa=0·85). The agreement was excellent for the major individual subtypes: large artery atherosclerosis kappa=0·888, small-artery occlusion kappa=0·869, cardiac embolism kappa=0·89, and undetermined category kappa=0·884. There was only moderate agreement (kappa=0·41) for the subjects with at least two competing underlying mechanism. Thirty-five (5·8%) patients classified as undetermined by Trial of ORG 10172 in Acute Stroke Treatment were assigned to a definite subtype by Causative Classification of Stroke system. Thirty-two subjects assigned to a definite subtype by Trial of ORG 10172 in Acute Stroke Treatment were classified as undetermined by Causative Classification of Stroke system. Conclusions: There is excellent agreement between classification using Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke systems but no evidence that Causative Classification of Stroke system reduced the proportion of patients classified to undetermined subtypes. The excellent inter-rater reproducibility and web-based semiautomated nature make Causative Classification of Stroke system suitable for multicenter studies, but the benefit of reclassifying cases already classified using the Trial of ORG 10172 in Acute Stroke Treatment system on existing databases is likely to be small.
KW - Genetics disorders
KW - Risk factors
KW - Stroke subtypes
UR - http://www.scopus.com/inward/record.url?scp=84873642955&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84873642955&partnerID=8YFLogxK
U2 - 10.1111/j.1747-4949.2012.00780.x
DO - 10.1111/j.1747-4949.2012.00780.x
M3 - Article
C2 - 22520626
AN - SCOPUS:84873642955
VL - 8
SP - 626
EP - 631
JO - International Journal of Stroke
JF - International Journal of Stroke
SN - 1747-4930
IS - 8
ER -