Dataset Information

Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study.

ABSTRACT: The objective of this study was to assess the level of agreement between stroke subtype classifications made using the Trial of Org 10172 Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems.Study subjects included 13,596 adult men and women accrued from 20 US and European genetic research centers participating in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN). All cases had independently classified TOAST and CCS stroke subtypes. Kappa statistics were calculated for the 5 major ischemic stroke subtypes common to both systems.The overall agreement between TOAST and CCS was moderate (agreement rate, 70%; ? = 0.59, 95% confidence interval [CI] 0.58-0.60). Agreement varied widely across study sites, ranging from 28% to 90%. Agreement on specific subtypes was highest for large-artery atherosclerosis (? = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (? = 0.56, 95% CI 0.54-0.58).Agreement between TOAST and CCS diagnoses was moderate. Caution is warranted when comparing or combining results based on the 2 systems. Replication of study results, for example, genome-wide association studies, should utilize phenotypes determined by the same classification system, ideally applied in the same manner.

SUBMITTER: McArdle PF

PROVIDER: S-EPMC4223086 | biostudies-other | 2014 Oct

REPOSITORIES: biostudies-other

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Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study.

McArdle Patrick F PF Kittner Steven J SJ Ay Hakan H Brown Robert D RD Meschia James F JF Rundek Tatjana T Wassertheil-Smoller Sylvia S Woo Daniel D Andsberg Gunnar G Biffi Alessandro A Brenner David A DA Cole John W JW Corriveau Roderick R de Bakker Paul I W PI Delavaran Hossein H Dichgans Martin M Grewal Raji P RP Gwinn Katrina K Huq Mohammed M Jern Christina C Jimenez-Conde Jordi J Jood Katarina K Kaplan Robert C RC Katschnig Petra P Katsnelson Michael M Labovitz Daniel L DL Lemmens Robin R Li Linxin L Lindgren Arne A Markus Hugh S HS Peddareddygari Leema R LR Pedersén Annie A Pera Joanna J Redfors Petra P Roquer Jaume J Rosand Jonathan J Rost Natalia S NS Rothwell Peter M PM Sacco Ralph L RL Sharma Pankaj P Slowik Agnieszka A Sudlow Cathie C Thijs Vincent V Tiedt Steffen S Valenti Raffaella R Worrall Bradford B BB

Neurology 20140926 18

<h4>Objective</h4>The objective of this study was to assess the level of agreement between stroke subtype classifications made using the Trial of Org 10172 Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems.<h4>Methods</h4>Study subjects included 13,596 adult men and women accrued from 20 US and European genetic research centers participating in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN). All cases had indep ...[more]

PMID: 25261504

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Project description:<p>The third leading cause of death in the United States, stroke is an acute neurological event leading to death of neural tissues. Although the majority of strokes are ischemic strokes, meaning there is oxygen deprivation to the brain, almost 20% of strokes are hemorrhagic, resulting from bleeding into the brain. Stroke is a complex disorder and likely multigenic in nature, resulting from a combination of genetic and environmental factors. These well characterized risk factors that contribute to the incidence of stroke include hypertension, cardiac disease, sickle cell disease, hyperhomocysteinemia, family history of stroke and smoking. </p> <p>ISGS aim is to perform a prospective genetic association study of ischemic stroke focusing on the hemostatic system. ISGS is a 5-center case-control study of first-ever ischemic stroke cases and concurrent controls individually matched for age, sex and recruitment site. </p> <p>This data includes that from subjects both banked in the <a href="http://ccr.coriell.org/Sections/Collections/NINDS/?SsId=10"> NINDS repository</a> with biologicals publicly available, and those whose samples are not banked/not available. </p>  <p>This study utilized the <a href="./study.cgi?id=phs000005">NINDS Repository Cerebrovascular/Stroke Study</a>, and <a href="./study.cgi?id=phs000004">neurologically normal controls</a> from the sample population which are banked in the National Institute of Neurological Disorders and Stroke (NINDS Repository) collection for a first stage whole genome analysis.</p>

Project description:BackgroundConflicting findings on the validity of self-reported stroke from existing studies creates uncertainty about the appropriateness of using self-reported stroke in epidemiological research. We aimed to compare self-reported stroke against hospital-recorded stroke, and investigate reasons for disagreement.MethodsWe included participants from the Australian Longitudinal Study on Women's Health born in 1921-26 (n?=?1556) and 1946-51 (n?=?2119), who were living in New South Wales and who returned all survey questionnaires over a defined period of time. We determined agreement between self-reported and hospitalised stroke by calculating sensitivity, specificity and kappa statistics. We investigated whether characteristics including age, education, area of residence, country of birth, language spoken at home, recent mental health at survey completion and proxy completion of questionnaire were associated with disagreement, using logistic regression analysis to obtain odds ratios (ORs) with 95% confidence intervals (CIs).ResultsAgreement between self-report and hospital-recorded stroke was fair in older women (kappa 0.35, 95% CI 0.25 to 0.46) and moderate in mid-aged women (0.56, 95% CI 0.37 to 0.75). There was a high proportion with unverified self-reported stroke, partly due to: reporting of transient ischaemic attacks; strokes occurring outside the period of interest; and possible reporting of stroke-like conditions. In the older cohort, a large proportion with unverified stroke had hospital records of other cerebrovascular disease. In both cohorts, higher education was associated with agreement, whereas recent poor mental health was associated with disagreement.ConclusionAmong women who returned survey questionnaires within the period of interest, validity of self-reported stroke was fair to moderate, but is probably underestimated. Agreement between self-report and hospital-recorded stroke was associated with individual characteristics. Where clinically verified stroke data are unavailable, self-report may be a reasonable alternative method of stroke ascertainment for some epidemiological studies.

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Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study.

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Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study.

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