Farzin Behzad, Fahed Robert, Guilbert Francois, Poppe Alexandre Y, Daneault Nicole, Durocher André P, Lanthier Sylvain, Boudjani Hayet, Khoury Naim N, Roy Daniel, Weill Alain, Gentric Jean-Christophe, Batista André L, Létourneau-Guillon Laurent, Bergeron François, Henry Marc-Antoine, Darsaut Tim E, Raymond Jean
From the Departments of Radiology (B.F., R.F., F.G., N.N.K., D.R., A.W., J.-C.G., A.L.B., L.L.-G., F.B., M.-A.H., J.R.) and Neurosciences (A.Y.P., N.D., A.P.D., S.L., H.B.), Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal; and the Department of Surgery, Division of Neurosurgery (T.E.D.), University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Canada.
Neurology. 2016 Jul 19;87(3):249-56. doi: 10.1212/WNL.0000000000002860. Epub 2016 Jun 17.
To systematically review the literature and assess agreement on the Alberta Stroke Program Early CT Score (ASPECTS) among clinicians involved in the management of thrombectomy candidates.
Studies assessing agreement using ASPECTS published from 2000 to 2015 were reviewed. Fifteen raters reviewed and scored the anonymized CT scans of 30 patients recruited in a local thrombectomy trial during 2 independent sessions, in order to study intrarater and interrater agreement. Agreement was measured using intraclass correlation coefficients (ICCs) and Fleiss kappa statistics for ASPECTS and dichotomized ASPECTS at various cutoff values.
The review yielded 30 articles reporting 40 measures of agreement. Populations, methods, analyses, and results were heterogeneous (slight to excellent agreement), precluding a meta-analysis. When analyzed as a categorical variable, intrarater agreement was slight to moderate (κ = 0.042-0.469); it reached a substantial level (κ > 0.6) in 11/15 raters when the score was dichotomized (0-5 vs 6-10). The interrater ICCs varied between 0.672 and 0.811, but agreement was slight to moderate (κ = 0.129-0.315). Even in the best of cases, when ASPECTS was dichotomized as 0-5 vs 6-10, interrater agreement did not reach a substantial level (κ = 0.561), which translates into at least 5 of 15 raters not giving the same dichotomized verdict in 15% of patients.
In patients considered for thrombectomy, there may be insufficient agreement between clinicians for ASPECTS to be reliably used as a criterion for treatment decisions.
系统回顾文献，并评估参与血栓切除术候选者管理的临床医生对阿尔伯塔卒中项目早期CT评分（ASPECTS）的一致性。
回顾2000年至2015年发表的使用ASPECTS评估一致性的研究。15名评估者在2个独立阶段对当地血栓切除术试验中招募的30例患者的匿名CT扫描进行评估和评分，以研究评估者内和评估者间的一致性。使用组内相关系数（ICC）和Fleiss κ统计量对ASPECTS以及不同临界值下的二分法ASPECTS进行一致性测量。
该综述产生了30篇报告40项一致性测量的文章。研究人群、方法、分析和结果存在异质性（一致性从轻微到极佳），因此无法进行荟萃分析。作为分类变量分析时，评估者内一致性为轻微到中等（κ = 0.042 - 0.469）；当评分二分法为（0 - 5与6 - 10）时，15名评估者中有11名达到了较高水平（κ > 0.6）。评估者间ICC在0.672至0.811之间变化，但一致性为轻微到中等（κ = 0.129 - 0.315）。即使在最佳情况下，当ASPECTS二分法为0 - 5与6 - 10时，评估者间一致性也未达到较高水平（κ = 0.561），这意味着15名评估者中至少有5名在15%的患者中未给出相同的二分法判断。
在考虑进行血栓切除术的患者中，临床医生之间对于将ASPECTS可靠地用作治疗决策标准的一致性可能不足。
