(Stroke. 2000;31:1602.)
© 2000 American Heart Association, Inc.
Original Contributions |
Validity of Self-Reported Stroke
The Tromsø Study
From the Institute of Community Medicine (T.E., K.H.B.) and the Institute of Clinical Medicine (K.H.B., M.V.), University of Tromsø, Tromsø, Norway, and the Division of Geriatric Medicine (M.V.), Karolinska Institute, Huddinge University Hospital, Huddinge, Sweden.
Correspondence to Torgeir Engstad, Faculty of Medicine, Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway.
Background and Purpose—The aim of this study was to validate the diagnosis of self-reported stroke.
Methods—During 1994–1995, 27 159 people attended a population health survey in the community of Tromsø, Norway, a response rate of 77%. A total of 418 attenders reported a history of stroke. In 1997, all individuals with a self-reported stroke who were still living in the community (n=362) were invited to a clinical reexamination. For each of the 269 people who were reexamined, a person who reported no history of stroke was selected and was reexamined in the same way.
Results—On the basis of the reexamination, 213 (79.2%) of the
self-reported strokes were confirmed. Thirteen individuals
(4.8%) had a possible stroke. The remaining 43 individuals had
either transient ischemic attack (TIA; n=18), traumatic head
injuries (n=16), or perinatal cerebral damage, complicated
migraine, syncope, possible TIA, or cerebral aneurysm
without bleeding (n=9). Among the confirmed strokes, 30 (14.1%) were
hemorrhagic and 118 (55.4%) were thromboembolic. Of the 30
hemorrhages, 16 were subarachnoidal bleedings, 10 due
to ruptured aneurysms. The histories of stroke, including both
the symptoms and the signs, often had a paucity of details and
precision, making it impossible to classify 65 stroke victims (30.5%)
into stroke subtypes. The positive predictive value (PPV) of a
self-reported stroke was 0.79. The PPV was significantly
(P=0.016) greater in men (0.88) than in women (0.73).
Individuals older than 60 years had a significantly greater PPV than
those younger than 60 years (PPV 0.83 and 0.73, respectively;
P=0.05). Hypertension was associated with a greater PPV,
whereas a history of either ischemic heart disease, diabetes
mellitus, lung disease, or depression had no impact on the PPV. The
estimated sensitivity of self-reported stroke in the survey population
was 
80% and the specificity was 99%.
Conclusions—We conclude that a self-administered questionnaire can be used to assess the prevalence of stroke in epidemiological research.
Key Words: diagnosis • epidemiology • stroke classification
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