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Stroke. 1995;26:46-51

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(Stroke. 1995;26:46-51.)
© 1995 American Heart Association, Inc.

Articles

Interrater Reliability of an Etiologic Classification of Ischemic Stroke

C. J. Johnson, MD, MS; S. J. Kittner, MD, MPH; R. J. McCarter, ScD; M. A. Sloan, MD; B. J. Stern, MD; D. Buchholz, MD T. R. Price, MD

From the Department of Neurology, Johns Hopkins Bayview (C.J.J.); the Departments of Neurology (S.J.K., M.A.S., T.R.P.) and Epidemiology and Preventive Medicine (S.J.K., R.J.M., M.A.S., T.R.P.), University of Maryland School of Medicine; the Department of Neurology, Johns Hopkins University School of Medicine (C.J.J., B.J.S., D.B.); and the Division of Neurology, Department of Medicine, Sinai Hospital (B.J.S.), Baltimore, Md.

Correspondence to Constance J. Johnson, MD, MS, Department of Neurology, Johns Hopkins Bayview, 4940 Eastern Ave, Baltimore, MD 21224.

Background and Purpose Precise identification of the cause of stroke is critical to research and clinical practice. Published series of ischemic stroke show considerable variation in the proportion of cases classified as atherosclerotic large-vessel disease, lacunar infarct, cardioembolic stroke, stroke of other known cause, and stroke of undetermined etiology. We describe the development and use of an etiology-specific classification of ischemic stroke. The interrater reliability of the classification is then evaluated.

Methods A total of 160 cases of ischemic strokes in young adults were reviewed by paired neurologists who assigned cases to prioritized categories. The results of paired ratings were evaluated for each of the potential causes. Interrater agreement was assessed by means of {kappa}, which is the chance-adjusted percent agreement.

Results For standard pairs, {kappa} was fair to good for all causes except lacunar stroke ({kappa}=0.31); however, pair-to-pair variation was greatest for lacunar strokes. Strokes of undetermined cause and hematologic/other cause were of borderline fair reliability.

Conclusions The utility of a stroke classification system is dependent on its intended use. An etiologic classification is useful in studies of the epidemiology and pathophysiological basis of stroke. Fair to good reliability for an etiologic classification of stroke can be obtained when criteria are explicit.


Key Words: cerebral ischemia • stroke assessment • stroke classification




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