You are here

Article Text

Article menu

Download PDFPDF

Original article
Ischaemic stroke etiological classification system: the agreement analysis of CISS, SPARKLE and TOAST
  1. Haojie Zhang1,2,
  2. Zixiao Li2,
  3. Yunyi Dai3,
  4. Enhui Guo4,
  5. Changqing Zhang2,
  6. Yongjun Wang2
  1. 1 Department of Neurological Rehabilitation, China Rehabilitation Research Center, Beijing, China
  2. 2 Department of Neurology, Beijing Tiantan Hospital, Beijing, China
  3. 3 Department of Neurology, First People’s Hospital of Shangqiu, Shangqiu, China
  4. 4 Department of Neurology, First People’s Hospital of Pingdingshan City, Pingdingshan, China
  1. Correspondence to Dr Yongjun Wang; yongjunwang{at}ncrcnd.org.cn

Abstract

Background and purpose The ideal stroke classification system needs to have validity, high reliability and applicability among different stroke research settings. The Chinese Ischemic Stroke Subclassification (CISS) and the Subtypes of Ischemic Stroke Classification System (SPARKLE) have emerged recently but have not been tested using agreement analysis. As a result, the objective of this study is to investigate the level of agreement among stroke subtype classifications using CISS, SPARKLE and Trial of Org 10172 in Acute Stroke Treatment (TOAST). We also analyse the inter-rater reliability of CISS.

Methods The data include 623 inpatients who have had an ischaemic stroke, accrued from Beijing Tiantan Hospital between 1 October 2015 and 19 April 2016. According to the diagnostic standards of the three subtype classification systems, 299 inpatients who satisfied the requirements of our study were independently classified with etiological subtypes, and we compared the three subclassifications.

Results There was substantial overall agreement among the three classification systems: CISS versus SPARKLE (kappa value=0.684, p<0.001), CISS versus TOAST (kappa value=0.615, p<0.001) and SPARKLE versus TOAST (kappa value=0.675, p<0.001). The inter-rater reliability of CISS was excellent (kappa value=0.857, p<0.001). Furthermore, among the three subtype classification systems, the variance analysis results of the etiological subtypes were not uniform.

Conclusion There were generally substantial agreements among three ischaemic stroke etiological classification systems. CISS is a valid and reliable classification system, with which different stroke research centres can apply and compare data.

  • ischemic stroke
  • etiology
  • classification system

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2018-000226

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors HZ: had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis and drafting of the manuscript; YW: study concept and design, critical revision of the manuscript for important intellectual content and statistical analysis; ZL: designed data collection tools, revised the draft paper, critical revision of the manuscript for important intellectual content and statistical analysis; YD: acquisition of clinical data; EG: acquisition of imaging data; CZ: statistical analysis of data and critical revision of the manuscript for important intellectual content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

    • Patient consent for publication Not required.