Journal article
Interphysician agreement in the diagnosis of subtypes of acute ischemic stroke : implications for clinical trials
Neurology, Vol.43(5), pp.1021-1027
1993
DOI: 10.1212/WNL.43.5.1021
PMID: 8492920
Abstract
To test interphysician agreement on the diagnosis of subtype of ischemic stroke, we sent subtype definitions and 18 case summaries (clinical features and pertinent laboratory data) to 24 neurologists who have a special interest in stroke, and asked them to determine the most likely subtype diagnosis. The overall agreement was 0.64 (Kappa [K] = 0.54). Interphysician agreement was highest for the diagnoses of stroke secondary to cardioembolism (K = 0.75) or to large-artery atherosclerosis (K = 0.69). Individual physicians varied widely; four agreed with the consensus diagnosis in all 18 cases, while six others disagreed with the consensus diagnosis in three to five cases. Our level of interphysician agreement is greater than that reported in other studies and was substantial. However, despite using subtype definitions and being given extensive information often not available in the acute setting, physicians still disagree about the etiology of stroke, particularly in regard to stroke due to small-artery occlusion or of undetermined etiology. Physicians seem reluctant not to attribute stroke to a specific etiology. The uncertainty about subtype diagnosis will affect interpretation of the results of clinical trials in patients selected by the subtype of ischemic stroke and also suggests that results of treatment as affected by subtype should be cautiously interpreted unless efforts to assure uniformity are included in the trial's operations. Refinement of algorithms for determining subtype of ischemic stroke do improve interphysician agreement. Such criteria should be applied strictly, and trials should include measures to assure the most uniform diagnosis of stroke subtype possible.
Details
- Title: Subtitle
- Interphysician agreement in the diagnosis of subtypes of acute ischemic stroke : implications for clinical trials
- Creators
- D. L GORDON - Univ. Iowa coll. medicine, dep. neurology, div. cerebrosvascular disease, Iowa City IA, United StatesB. H BENDIXEN - Univ. Iowa coll. medicine, dep. neurology, div. cerebrosvascular disease, Iowa City IA, United StatesH. P ADAMS - Univ. Iowa coll. medicine, dep. neurology, div. cerebrosvascular disease, Iowa City IA, United StatesW CLARKE - Univ. Iowa coll. medicine, dep. neurology, div. cerebrosvascular disease, Iowa City IA, United StatesL. J KAPPELLE - Univ. Iowa coll. medicine, dep. neurology, div. cerebrosvascular disease, Iowa City IA, United StatesR. F WOOLSON - Univ. Iowa coll. medicine, dep. neurology, div. cerebrosvascular disease, Iowa City IA, United States
- Resource Type
- Journal article
- Publication Details
- Neurology, Vol.43(5), pp.1021-1027
- Publisher
- Lippincott Williams & Wilkins; Hagerstown, MD
- DOI
- 10.1212/WNL.43.5.1021
- PMID
- 8492920
- ISSN
- 0028-3878
- eISSN
- 1526-632X
- Language
- English
- Date published
- 1993
- Academic Unit
- Statistics and Actuarial Science; Neurology; Epidemiology; Iowa Neuroscience Institute; Biostatistics
- Record Identifier
- 9984020724602771
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