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Agreement between TOAST and CCS ischemic stroke classification The NINDS SiGN Study

McArdle, Patrick F.; Kittner, Steven J.; Ay, Hakan; Brown Jr., Robert D.; Meschia, James F.; Rundek, Tatjana; Wassertheil-Smoller, Sylvia; Woo, Daniel; Andsberg, Gunnar LU and Biffi, Alessandro, et al. (2014) In Neurology 83(18). p.1653-1660
Abstract
Objective: 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. Methods: 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. Results: The overall agreement between TOAST and CCS was moderate (agreement rate, 70%; kappa = 0.59, 95%... (More)
Objective: 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. Methods: 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. Results: The overall agreement between TOAST and CCS was moderate (agreement rate, 70%; kappa = 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 (kappa = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (kappa = 0.56, 95% CI 0.54-0.58). Conclusion: 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. (Less)
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published
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Neurology
volume
83
issue
18
pages
1653 - 1660
publisher
American Academy of Neurology
external identifiers
  • wos:000344852200015
  • scopus:84922392515
ISSN
1526-632X
DOI
10.1212/WNL.0000000000000942
language
English
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yes
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6b86fd9f-d515-4b1b-837f-c3fbf563f703 (old id 4985591)
date added to LUP
2015-02-03 07:14:58
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2017-09-17 06:58:23
@article{6b86fd9f-d515-4b1b-837f-c3fbf563f703,
  abstract     = {Objective: 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. Methods: 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. Results: The overall agreement between TOAST and CCS was moderate (agreement rate, 70%; kappa = 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 (kappa = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (kappa = 0.56, 95% CI 0.54-0.58). Conclusion: 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.},
  author       = {McArdle, Patrick F. and Kittner, Steven J. and Ay, Hakan and Brown Jr., Robert D. and Meschia, James F. and Rundek, Tatjana and Wassertheil-Smoller, Sylvia and Woo, Daniel and Andsberg, Gunnar and Biffi, Alessandro and Brenner, David A. and Cole, John W. and Corriveau, Roderick and de Bakker, Paul I. W. and Delavaran, Hossein and Dichgans, Martin and Grewal, Raji P. and Gwinn, Katrina and Huq, Mohammed and Jern, Christina and Jimenez-Conde, Jordi and Jood, Katarina and Kaplan, Robert C. and Katschnig, Petra and Katsnelson, Michael and Labovitz, Daniel L. and Lemmens, Robin and Li, Linxin and Lindgren, Arne and Markus, Hugh S. and Peddareddygari, Leema R. and Pedersen, Annie and Pera, Joanna and Redfors, Petra and Roquer, Jaume and Rosand, Jonathan and Rost, Natalia S. and Rothwell, Peter M. and Sacco, Ralph L. and Sharma, Pankaj and Slowik, Agnieszka and Sudlow, Cathie and Thijs, Vincent and Tiedt, Steffen and Valenti, Raffaella and Worrall, Bradford B.},
  issn         = {1526-632X},
  language     = {eng},
  number       = {18},
  pages        = {1653--1660},
  publisher    = {American Academy of Neurology},
  series       = {Neurology},
  title        = {Agreement between TOAST and CCS ischemic stroke classification The NINDS SiGN Study},
  url          = {http://dx.doi.org/10.1212/WNL.0000000000000942},
  volume       = {83},
  year         = {2014},
}