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(Stroke. 2003;34:565.)
© 2003 American Heart Association, Inc.

Research Report

Interobserver Agreement in the Classification of Stroke in the Women’s Health Study

Monika Atiya, MD; Tobias Kurth, MD, MSc; Klaus Berger, MD, MPH, MSc; Julie E. Buring, ScD Carlos S. Kase, MD

From the Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital (M.A., T.K., K.B., J.E.B.) and Department of Ambulatory Care and Prevention (J.E.B.), Harvard Medical School, Boston, Mass; Department of Epidemiology, Harvard School of Public Health, Boston, Mass (T.K., J.E.B.); Institute of Epidemiology and Social Medicine (K.B.), University of Muenster, Muenster, Germany; and Department of Neurology, Boston University Medical Center, Boston, Mass (C.S.K.).

Correspondence to Tobias Kurth, MD, MSc, Brigham and Women’s Hospital, Division of Preventive Medicine, 900 Commonwealth Ave E, Boston, MA 02215-1204. E-mail tkurth{at}rics.bwh.harvard.edu

Abstract

Background and Purpose— Accurate classification of stroke events is essential in large cohort studies of risk factor assessment and in treatment trials such as the Women’s Health Study (WHS).

Methods— Based on medical record review, we assessed interrater reliability in stroke classification and disability status in the WHS using the statistic.

Results— During 7.0 years of follow-up, 271 incident strokes occurred, of which 133 were reclassified. There was excellent interrater agreement in the diagnosis of major stroke types, hemorrhagic subtypes, and degree of disability, as well as substantial agreement in the definition of the vascular territory involved. Only moderate agreement was reached in the classification of ischemic subtypes.

Conclusions— Major stroke types, degree of disability, and vascular territory involved can be reliably classified on the basis of a review of medical records in the WHS, whereas classification of ischemic stroke subtypes needs further refinement of diagnostic criteria.

Key Words: classification • diagnosis • interobserver variation • stroke

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