基于回顾性病历审查的急性中风治疗中org 10172试验的观察者间一致性：中风分类。
Interobserver agreement in the trial of org 10172 in acute stroke treatment classification of stroke based on retrospective medical record review.
作者信息
Meschia James F, Barrett Kevin M, Chukwudelunzu Felix, Brown W Mark, Case L Douglas, Kissela Brett M, Brown Robert D, Brott Thomas G, Olson Tammy S, Rich Stephen S, Silliman Scott, Worrall Bradford B
机构信息
Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.
出版信息
J Stroke Cerebrovasc Dis. 2006 Nov-Dec;15(6):266-72. doi: 10.1016/j.jstrokecerebrovasdis.2006.07.001.
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.
背景
在受中风影响的先证者的兄弟姐妹中，急性中风治疗中Org 10172试验（TOAST）中风分类系统的可靠性尚未得到检验。同样，使用临床病历对缺血性中风进行分类的可靠性也未得到评估。本研究的目的是通过将TOAST标准应用于回顾性获取的病历，建立兄弟姐妹中风亚型分类的评分者间信度。
方法
从所有先前被缺血性中风研究（SWISS）中风验证委员会分类为中风的兄弟姐妹的记录中随机抽取30份病历。将这些个体的盲态病历发送给6名医生审阅者，他们根据病历审查独立对TOAST中风亚型进行分类。
结果
使用kappa统计量评估评分者间信度，分配TOAST中风亚型的总体信度（SE）为0.54（0.03）。原始SWISS中风验证委员会诊断与其他审阅者诊断之间的两两比较显示出中等信度（kappa范围为0.41 - 0.56）。常见中风亚型的kappa统计量分别为：大动脉型，0.80（0.06）；心源性栓塞型，0.80（0.06）；小血管型，0.53（0.06）；病因不明型，0.40（0.06）。
结论
我们得出结论，TOAST亚型分类具有中等的评分者间信度。大动脉型和心源性栓塞型亚型诊断似乎最可靠。
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