Lindley R I, Warlow C P, Wardlaw J M, Dennis M S, Slattery J, Sandercock P A
Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, UK.
Stroke. 1993 Dec;24(12):1801-4. doi: 10.1161/01.str.24.12.1801.
The Oxfordshire Community Stroke Project (OCSP) clinical classification of subtypes of cerebral infarction (total and partial anterior circulation infarction, lacunar infarction, and posterior circulation infarction) can be used to predict early mortality, functional outcome, and whether the infarct was likely due to large- or small-vessel occlusion. The OCSP classification was originally developed and tested by neurologists as part of a community-based study of first-ever stroke, in which some cases were seen after the acute phase. We examined the interobserver reliability of the classification when used in everyday clinical practice in patients seen during the acute phase of stroke shortly after admission to the hospital.
Two clinicians independently assessed consecutive patients admitted to the hospital with an acute stroke and recorded both the neurological features and their opinion of the subtype of infarct.
Eighty-five patients were assessed. Interobserver agreement for the classification was moderate to good (kappa = 0.54; 95% confidence interval, 0.39 to 0.68). Differences in the assessment of the commonly elicited neurological signs explained many of the disagreements: interobserver agreement was good for some signs (hemiparesis [kappa = 0.77], dysphasia [kappa = 0.70]), moderate for some (hemianopia [kappa = 0.39]), and poor for others (sensory loss [kappa = 0.15]).
The classification was simple and practicable (and could be widely used in routine clinical practice, randomized controlled trials, and audit), and interobserver reliability was satisfactory.
牛津郡社区卒中项目（OCSP）对脑梗死亚型（完全性和部分性前循环梗死、腔隙性梗死及后循环梗死）的临床分类可用于预测早期死亡率、功能转归以及梗死是否可能由大血管或小血管闭塞所致。OCSP分类最初由神经科医生作为一项基于社区的首次卒中研究的一部分而制定和测试，其中一些病例是在急性期过后观察的。我们研究了该分类在卒中急性期患者入院后不久的日常临床实践中使用时观察者间的可靠性。
两名临床医生独立评估连续入院的急性卒中患者，并记录神经学特征及其对梗死亚型的判断。
共评估了85例患者。观察者间对分类的一致性为中等至良好（kappa = 0.54；95%置信区间，0.39至0.68）。对常见引出的神经学体征评估的差异解释了许多分歧：观察者间对某些体征的一致性良好（偏瘫[kappa = 0.77]、失语[kappa = 0.70]），对某些体征为中等（偏盲[kappa = 0.39]），而对其他体征则较差（感觉丧失[kappa = 0.15]）。
该分类简单可行（可广泛应用于常规临床实践、随机对照试验及审核），观察者间可靠性令人满意。
