Ischaemic stroke etiological classification system: the agreement analysis of CISS, SPARKLE and TOAST

Abstract

Background and purposeThe 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.MethodsThe 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.ResultsThere 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.ConclusionThere 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.

Differential value of intima thickness in ischaemic stroke due to large‐artery atherosclerosis and small‐vessel occlusion

“…According to an aetiology-based classification criteria (Trial of Org 10172 in Acute Stroke Treatment, TOAST), stroke subtypes should be classified as large-artery atherosclerosis (LAA),small-vessel occlusion (SVO), cardioembolism, stroke of other determined aetiology and stroke of undetermined aetiology, 1 with the first two being predominant in China. 2,3 The pathologies in the different stroke subtypes are heterogeneous. Pathological changes in LAA include atherosclerosis, 4 which…”

“…small-vessel occlusion (SVO), cardioembolism, stroke of other determined aetiology and stroke of undetermined aetiology, 1 with the first two being predominant in China. 2,3 The pathologies in the different stroke subtypes are heterogeneous. Pathological changes in LAA include atherosclerosis, 4 which…”

Multimodal Retinal Imaging for Detection of Ischemic Stroke

“…For example, the diagnostic criteria of small-vessel occlusion are too loose to consider the different pathological changes of this subtype. Many cases that were previously considered as small-vessel occlusion subtypes should be identified as large-artery atherosclerosis subtypes (Gao et al, 2011 ; Chen et al, 2012 ; Zhang et al, 2019 ). Considering the aforementioned reasons, this study included these two subtypes.…”

Endarterectomy for symptomatic non-stenotic carotids: a systematic review and descriptive analysis

“…More recent classification systems have therefore defined large artery atherosclerosis by the degree of plaque burden as opposed to the per cent Open access luminal stenosis. 25 In turn, this classification system reclassifies some patients with ESUS as having large artery (ie, carotid artery) atherosclerosis.…”