Jpn Heart J. 1977 Mar;18(2):171-7. doi: 10.1536/ihj.18.171.
Validity and consistency of the diagnosis of stroke and its types were tested with 60 case reports including 15 diguised duplicates, drawn at random from community-based stroke registers. Seven European, 5 Japanese, and 5 other centers participated the test. The diagnosis of stroke as such (regardless of its type) seems to have been established accurately in all the 3 groups of centers; this leads to the conclusion that the incidence rates of stroke as registered in the participating centers were comparable. The diagnosis of the types of stroke was less reliable, since intra-and inter-observer bias was found in the diagnosis of the identical sample of test cases. In some European centers, the type of stroke was rarely determined, unless objective and definitive evidences were available. The Japanese centers appeared to have diagnosed the type of stroke in a relatively more uniform way between centers, however, the consistency of the diagnosis at separate times was lower. Subarachnoid hemorrhage, when diagnosed, was generally based on firmer gounds. These observations were confirmed in a small number of autopsy-verified cases. These varying diagnostic attitudes introduce false differences. Such "softness" of type-diagnosis must be borne in mind when comparison of type of stroke at different times or between populations is attempted.
利用从社区卒中登记处随机抽取的60份病例报告（包括15份伪装的重复病例），对卒中诊断及其类型的有效性和一致性进行了测试。七个欧洲中心、五个日本中心和五个其他中心参与了此次测试。在所有三组中心中，卒中本身（无论其类型）的诊断似乎都已准确确立；由此得出结论，参与中心登记的卒中发病率具有可比性。卒中类型的诊断不太可靠，因为在对相同测试病例样本的诊断中发现了观察者内部和观察者之间的偏差。在一些欧洲中心，除非有客观确凿的证据，否则很少确定卒中类型。日本中心在各中心之间似乎以相对更统一的方式诊断卒中类型，然而，不同时间诊断的一致性较低。蛛网膜下腔出血一旦被诊断，通常有更确凿的依据。这些观察结果在少数经尸检证实的病例中得到了证实。这些不同的诊断态度造成了虚假差异。在试图比较不同时间或不同人群之间的卒中类型时，必须牢记这种类型诊断的“不精确性”。
