Stroke, Vol 24, 1801-1804, Copyright © 1993 by American Heart Association
RI Lindley, CP Warlow, JM Wardlaw, MS Dennis, J Slattery and PA Sandercock
BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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]). CONCLUSIONS: 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.
ARTICLES
Interobserver reliability of a clinical classification of acute cerebral infarction
Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, UK.
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