Published Online
on April 17, 2003

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

This Article Full Text (PDF) Correction (v34,p1573) All Versions of this Article: 34/5/1156    most recent 01.STR.0000069012.23858.69v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Al-Shahi, R. Articles by Warlow, C. P. Search for Related Content PubMed PubMed Citation Articles by Al-Shahi, R. Articles by Warlow, C. P. Related Collections Acute Cerebral Hemorrhage Cerebral Aneurysm, AVM, & Subarachnoid hemorrhage Aneurysm, AVM, hematoma

Submitted on November 12, 2002
Accepted on December 2, 2002

Scottish Intracranial Vascular Malformation Study (SIVMS). Evaluation of Methods, ICD-10 Coding, and Potential Sources of Bias in a Prospective, Population-Based Cohort

Rustam Al-Shahi MA, MRCP(UK)^*; Jo J. Bhattacharya FRCR; David G. Currie FRCS; Vakis Papanastassiou FRCS; Vaughn Ritchie MB, ChB; Richard C. Roberts FRCP; Robin J. Sellar FRCR; Charles P. Warlow FRCP; and for the SIVMS Collaborators

From the Department of Clinical Neurosciences, Western General Hospital, Edinburgh (R.A-S., R.J.S., C.P.W.); Institute of Neurological Sciences, Southern General Hospital, Glasgow (J.J.B., V.P.); Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen (D.G.C.); Fauldhouse Health Centre, Fauldhouse (V.R.); and Department of Neurology, Ninewells Hospital and Medical School, Dundee (R.C.R.), Scotland.

^* To whom correspondence should be addressed. E-mail: Rustam.Al-Shahi{at}ed.ac.uk.

Background and Purpose--The rarity of intracranial vascular malformations (IVMs) and the infrequency of their outcomes make large, prolonged cohort studies the best means to evaluate their frequency and prognosis.

Methods--The Scottish Intracranial Vascular Malformation Study (SIVMS) is a prototype prospective, population-based study of adults resident in Scotland and diagnosed for the first time with an IVM after January 1, 1999. We evaluated the design of SIVMS using 2 complete years of data for adults with arteriovenous malformations (AVMs) of the brain.

Results--A collaborative network of clinicians, radiologists, and pathologists, combined with coding of hospital discharge data and death certificates, recruited a cohort distributed in proportion to the Scottish population. Coding (with International Classification of Diseases, 10th Revision [ICD-10] codes Q28.2 and I60.8) had a sensitivity of 72% (95% CI, 61% to 80%) and a positive predictive value of 46% (95% CI, 38% to 55%) for detecting incident brain AVMs. Adults who were detected by coding alone were significantly (P<0.05) younger, more likely to present with hemorrhage, more frequently investigated with catheter angiography, and more likely to be treated. Adults recruited from tertiary referral centers were significantly more likely to be investigated with catheter angiography and to be treated. Using catheter angiography as a diagnostic requirement for brain AVMs significantly biases the cohort toward younger adults presenting with hemorrhage and receiving treatment.

Conclusions--Population-based studies of IVM frequency and prognosis should use multiple overlapping sources of case ascertainment, and such studies of brain AVMs should not require catheter angiography to be the diagnostic standard.

Key words: central nervous system • cerebral arteriovenous malformations • incidence • prognosis • registries • vascular malformations

This article has been cited by other articles:

				C. F. Kelley, W. Checkley, D. M. Mannino, C. Franco-Paredes, C. Del Rio, and F. Holguin Trends in Hospitalizations for AIDS-Associated Pneumocystis jirovecii Pneumonia in the United States (1986 to 2005) Chest, July 1, 2009; 136(1): 190 - 197. [Abstract] [Full Text] [PDF]

				C. E. Miller, Z. Quayyum, P. McNamee, R. Al-Shahi Salman, and on behalf of the SIVMS Steering Committee Economic Burden of Intracranial Vascular Malformations in Adults: Prospective Population-Based Study Stroke, June 1, 2009; 40(6): 1973 - 1979. [Abstract] [Full Text] [PDF]

				J. M.L. Hon, J. J. Bhattacharya, C. E. Counsell, V. Papanastassiou, V. Ritchie, R. C. Roberts, R. J. Sellar, C. P. Warlow, R. Al-Shahi Salman, and on behalf of the SIVMS Collaborators The Presentation and Clinical Course of Intracranial Developmental Venous Anomalies in Adults: A Systematic Review and Prospective, Population-Based Study Stroke, June 1, 2009; 40(6): 1980 - 1985. [Abstract] [Full Text] [PDF]

				J. van Beijnum, C. E. Lovelock, C. Cordonnier, P. M. Rothwell, C. J. M. Klijn, R. Al-Shahi Salman, and on behalf of the SIVMS Steering Committee and the Outcome after spontaneous and arteriovenous malformation-related intracerebral haemorrhage: population-based studies Brain, February 1, 2009; 132(2): 537 - 543. [Abstract] [Full Text] [PDF]

				J. van Beijnum, J. J. Bhattacharya, C. E. Counsell, V. Papanastassiou, V. Ritchie, R. C. Roberts, R. J. Sellar, C. Warlow, R. A.-S. Salman, and on behalf of the SIVMS Collaborators Patterns of Brain Arteriovenous Malformation Treatment: Prospective, Population-Based Study Stroke, December 1, 2008; 39(12): 3216 - 3221. [Abstract] [Full Text] [PDF]

				C Cordonnier, R A.-S. Salman, J J Bhattacharya, C E Counsell, V Papanastassiou, V Ritchie, R C Roberts, R J Sellar, C Warlow, and SIVMS Collaborators Differences between intracranial vascular malformation types in the characteristics of their presenting haemorrhages: prospective, population-based study J. Neurol. Neurosurg. Psychiatry, January 1, 2008; 79(1): 47 - 51. [Abstract] [Full Text] [PDF]

				B. T. Bateman, H. C. Schumacher, C. D. Bushnell, J. Pile-Spellman, L. L. Simpson, R. L. Sacco, and M. F. Berman Intracerebral hemorrhage in pregnancy: Frequency, risk factors, and outcome Neurology, August 8, 2006; 67(3): 424 - 429. [Abstract] [Full Text] [PDF]

				R. Al-Shahi, C. Vousden, C. Warlow, and for the Scottish Intracranial Vascular Malformatio Bias from requiring explicit consent from all participants in observational research: prospective, population based study BMJ, October 22, 2005; 331(7522): 942. [Abstract] [Full Text] [PDF]

				A. X. Halim, S. C. Johnston, V. Singh, C. E. McCulloch, J. P. Bennett, A. S. Achrol, S. Sidney, and W. L. Young Longitudinal Risk of Intracranial Hemorrhage in Patients With Arteriovenous Malformation of the Brain Within a Defined Population Stroke, July 1, 2004; 35(7): 1697 - 1702. [Abstract] [Full Text] [PDF]

				R. Al-Shahi, J. J. Bhattacharya, D. G. Currie, V. Papanastassiou, V. Ritchie, R. C. Roberts, R. J. Sellar, and C. P. Warlow Prospective, Population-Based Detection of Intracranial Vascular Malformations in Adults: The Scottish Intracranial Vascular Malformation Study (SIVMS) Stroke, May 1, 2003; 34(5): 1163 - 1169. [Abstract] [Full Text] [PDF]