Yang Xiao-Li, Zhu De-Sheng, Lv Hui-Hui, Huang Xin-Xin, Han Yan, Wu Shuai, Guan Yang-Tai
Department of Neurology, the Fifth People's Hospital of Shanghai, Fudan University.
Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University.
Neurologist. 2019 Jul;24(4):111-114. doi: 10.1097/NRL.0000000000000236.
To assess the impact of observer's experience on reliability of etiological classification systems in patients with ischemic stroke.
We retrospectively reviewed medical records of 80 patients with ischemic stroke in hospitals from August 2016 to March 2017 consecutively. Patients were classified by 4 observers with different clinical experiences and backgrounds (A, B, C, and D) according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST), Stop Stroke Study TOAST (SSS-TOAST), and ASCOD (A-atherosclerosis, S-small vessel disease, C-cardiac pathology, O-other cause, and D-dissection). The intraobserver reliability was assessed based on the initial and a second delayed assessment after 3 months, and the interobserver reliability of different pairs (A-B and C-D) and overall (A, B, C, and D) were compared based on the initial classification.
The reliability values of the 3 classification systems were improved with observer's experience increasing, particularly in the TOAST system, in which the intraobserver reliability values of observers A, B, C, and D were 0.62, 0.73, 0.80, and 0.88, respectively, and slight differences were observed between the SSS-TOAST and ASCOD systems. The A-B pair had lower interobserver reliability value than the C-D pair, particularly in TOAST system with reliability values of 0.36 and 0.74, respectively, and a slight variation of interobserver reliability values were noted in the SSS-TOAST and ASCOD system.
Observer's experience may affect the reliability of etiological classification systems in patients with ischemic stroke.
评估观察者经验对缺血性脑卒中患者病因分类系统可靠性的影响。
我们回顾性连续分析了2016年8月至2017年3月期间医院收治的80例缺血性脑卒中患者的病历。4名具有不同临床经验和背景的观察者（A、B、C和D）根据急性卒中治疗中ORG 10172试验（TOAST）、停止卒中研究TOAST（SSS - TOAST）以及ASCOD（A - 动脉粥样硬化，S - 小血管疾病，C - 心脏病变，O - 其他原因，D - 夹层）对患者进行分类。基于初始评估和3个月后的第二次延迟评估来评估观察者内可靠性，并根据初始分类比较不同配对（A - B和C - D）以及总体（A、B、C和D）的观察者间可靠性。
随着观察者经验的增加，3种分类系统的可靠性值均有所提高，尤其是在TOAST系统中，观察者A、B、C和D的观察者内可靠性值分别为0.62、0.73、0.80和0.88，SSS - TOAST和ASCOD系统之间观察到细微差异。A - B配对的观察者间可靠性值低于C - D配对，尤其是在TOAST系统中，可靠性值分别为0.36和0.74，在SSS - TOAST和ASCOD系统中观察者间可靠性值有轻微变化。
观察者经验可能会影响缺血性脑卒中患者病因分类系统的可靠性。
