Published Online
on April 8, 2004

A more recent version of this article appeared on May 1, 2004

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Submitted on November 20, 2003
Accepted on January 21, 2004

Interobserver Variation of ASPECTS in Real Time

Shelagh B. Coutts MBChB^*; Andrew M. Demchuk MD; Philip A. Barber MBChB; William Y. Hu MD; Jessica E. Simon MBChB; Alastair M. Buchan MD; Michael D. Hill MD; for the VISION Study Group

From Seaman Family MR Research Centre (S.B.C., A.M.D., J.E.S., A.M.B.), Foothills Medical Centre, Calgary Health Region; Departments of Clinical Neurosciences (S.B.C., A.M.D., P.A.B., W.Y.H., J.E.S., A.M.B., M.D.H.), Medicine (M.D.H.), Community Health Sciences (M.D.H.), and Radiology (W.Y.H.), University of Calgary; Calgary, Alberta, Canada.

^* To whom correspondence should be addressed. E-mail: shelagh.coutts{at}calgaryhealthregion.ca.

Background--The Alberta Stroke Program Early CT Score (ASPECTS) has been used to quantify early ischemic changes on computed tomography (CT) brain scans of acute stroke patients. We sought to assess the reliability of the score when performed in real time as compared with an expert rating performed at a later time point.

Methods--Two hundred fourteen patients presenting with acute ischemic stroke or transient ischemic attack were prospectively recruited if they had a brain CT scan performed within 12 hours of symptom onset. Each scan was read for ASPECTS prospectively by the treating physician and later by 1 expert reader. A weighted kappa statistic was used to determine the interobserver agreement.

Results--The median baseline National Institutes of Health Stroke Scale score was 5 (range: 0 to 32) and the median time to CT scan was 152 minutes (range: 22 to 769). The interobserver agreement between ASPECTS performed in real time and expert ASPECTS was substantial (_w=0.69). The mean difference between real-time ASPECTS and expert ASPECTS was 0 (SD: 1.1).

Conclusions--ASPECTS is a reliable clinical scale for rating early ischemic changes on CT when performed in real time.

Key words: cerebral infarction • computed tomography

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