TY - JOUR
T1 - Agreement between TOAST and CCS ischemic stroke classification
T2 - The NINDS SiGN Study
AU - On Behalf Of The Ninds SiGN Study
AU - McArdle, Patrick F.
AU - Kittner, Steven J.
AU - Ay, Hakan
AU - Brown, Robert D.
AU - Meschia, James F.
AU - Rundek, Tatjana
AU - Wassertheil-Smoller, Sylvia
AU - Woo, Daniel
AU - Andsberg, Gunnar
AU - Biffi, Alessandro
AU - Brenner, David A.
AU - Cole, John W.
AU - Corriveau, Roderick
AU - De Bakker, Paul I.W.
AU - Delavaran, Hossein
AU - Dichgans, Martin
AU - Grewal, Raji P.
AU - Gwinn, Katrina
AU - Huq, Mohammed
AU - Jern, Christina
AU - Jimenez-Conde, Jordi
AU - Jood, Katarina
AU - Kaplan, Robert C.
AU - Katschnig, Petra
AU - Katsnelson, Michael
AU - Labovitz, Daniel L.
AU - Lemmens, Robin
AU - Li, Linxin
AU - Lindgren, Arne
AU - Markus, Hugh S.
AU - Peddareddygari, Leema R.
AU - Pedersén, Annie
AU - Pera, Joanna
AU - Redfors, Petra
AU - Roquer, Jaume
AU - Rosand, Jonathan
AU - Rost, Natalia S.
AU - Rothwell, Peter M.
AU - Sacco, Ralph L.
AU - Sharma, Pankaj
AU - Slowik, Agnieszka
AU - Sudlow, Cathie
AU - Thijs, Vincent
AU - Tiedt, Steffen
AU - Valenti, Raffaella
AU - Worrall, Bradford B.
N1 - Publisher Copyright:
© 2014 American Academy of Neurology.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - 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%; k = 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 (k = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (k = 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.
AB - 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%; k = 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 (k = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (k = 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.
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U2 - 10.1212/WNL.0000000000000942
DO - 10.1212/WNL.0000000000000942
M3 - Article
C2 - 25261504
AN - SCOPUS:84922392515
SN - 0028-3878
VL - 83
SP - 1653
EP - 1660
JO - Neurology
JF - Neurology
IS - 18
ER -