Charidimou Andreas, Schmitt Anne, Wilson Duncan, Yakushiji Yusuke, Gregoire Simone M, Fox Zoe, Jäger Hans R, Werring David J
UCL Stroke Research Centre, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Hemorrhagic Stroke Research Group, Harvard Medical School, Massachusetts General Hospital, Boston, USA.
Lysholm Department of Neuroradiology, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
J Neurol Sci. 2017 Jan 15;372:178-183. doi: 10.1016/j.jns.2016.11.021. Epub 2016 Nov 12.
The causes, risk factors and prognosis of spontaneous intracerebral haemorrhage (ICH) are partly determined by anatomical location (specifically, lobar vs. non-lobar (deep and infratentorial) regions). We systematically developed a rating instrument to reliably classify ICH location.
We used a two-stage iterative Delphi-style method for instrument development. The resultant Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS) was validated on CT and MRI scans from a cohort of consecutive patients with acute spontaneous symptomatic ICH by three independent raters. We tested interrater and intrarater reliability using kappa statistics.
Our validation cohort included 227 patients (58% male; median age: 72.4 (IQR: 67.1-74.6)). The interrater reliability for the main analyses (i.e. including any lobar ICH; all deep and infratentorial anatomical categories (lentiform, caudate thalamus; brainstem; cerebellum); and uncertain location) was excellent (all kappa values>0.80) both in pair-wise between-rater comparisons and across all raters. The intrarater reliability was substantial to almost perfect (k=0.83; 95%CI: 0.77-0.88 and k=0.95; 95%CI: 0.92-0.96 respectively). All kappa statistics remained consistent for individual cerebral lobar regions.
The CHARTS instrument can be used to reliably and comprehensively map the anatomical location of spontaneous ICH, and may be helpful for studying important questions regarding causes, risk factors, prognosis, and for stratification in clinical trials.
自发性脑出血（ICH）的病因、危险因素及预后部分取决于解剖位置（具体而言，脑叶性与非脑叶性（深部和幕下）区域）。我们系统地开发了一种评分工具，以可靠地对ICH位置进行分类。
我们采用两阶段迭代的德尔菲法进行工具开发。最终的脑出血解剖评分工具（CHARTS）由三位独立评估者在一组连续的急性自发性症状性ICH患者的CT和MRI扫描上进行验证。我们使用kappa统计量测试评估者间和评估者内的可靠性。
我们的验证队列包括227名患者（58%为男性；中位年龄：72.4（四分位间距：67.1 - 74.6））。主要分析（即包括任何脑叶性ICH；所有深部和幕下解剖类别（豆状核、尾状丘脑；脑干；小脑）；以及位置不确定）的评估者间可靠性在评估者两两比较和所有评估者中均非常出色（所有kappa值>0.80）。评估者内可靠性为实质性到几乎完美（分别为k = 0.83；95%置信区间：0.77 - 0.88和k = 0.95；95%置信区间：0.92 - 0.96）。各个脑叶区域的所有kappa统计量均保持一致。
CHARTS工具可用于可靠且全面地描绘自发性ICH的解剖位置，可能有助于研究有关病因、危险因素、预后的重要问题，以及用于临床试验中的分层。
