Published Online
on January 16, 2003

A more recent version of this article appeared on February 1, 2003

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Submitted on August 29, 2002
Accepted on September 12, 2002

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; and 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.).

^* To whom correspondence should be addressed. E-mail: tkurth{at}rics.bwh.harvard.edu.

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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