Towards a Consensus-Based Classification of Childhood Arterial Ischemic Stroke

• DOI: 10.1161/strokeaha.111.624585
• Publication Date: 2011-12-09T07:29:06Z
• Authors: Timothy J. Bernard; Marilyn J. Manco-...; Warren Lo; Mark T. MacKay; Vijeya Ganesan; Gabrielle deVeber; Neil A. Goldenberg; Jennifer Armstron...; Michael M. Dowling; E. Steve Roach; Mark Tripputi; Heather J. Fullerton; Karen L. Furie; Susanne M. Benseler; Lori C. Jordan; Adam Kirton; Rebecca Ichord
• Keywords: Stroke; Delphi Method; Cohen's kappa; Statistic; Etiology

Background and Purpose— The implementation of uniform nomenclature classification in adult arterial ischemic stroke (AIS) has been critical for defining outcomes recurrence risks according to etiology developing risk-stratified treatments. In contrast, current childhood AIS are often overlapping or contradictory. Our purpose was develop a comprehensive consensus-based system AIS. Methods— Using modified-Delphi method, members the International Pediatric Stroke Study (IPSS) developed Childhood Standardized Classification And Diagnostic Evaluation (CASCADE) criteria. Two groups pediatric specialists from IPSS classified 7 test cases using 2 methods each: (1) typical individual clinician's clinical practice; (2) based on CASCADE Group 1 underwent in-person training utilization same via an online survey, including definitions but without training. Inter-rater reliability (IRR) assessed multi-rater unweighted κ-statistic. Results— (with training), IRR improved criteria (κ=0.78, 95% CI=[0.49, 0.94]), compared with practice (κ=0.40, CI=[0.11, 0.60]). (without lower than among trained raters (κ=0.61, CI=[0.29, 0.77]), higher (κ=0.23, CI=[0.03, 0.36]). Conclusions— A new, AIS, criteria, can be used classify good IRR. These preliminary findings suggest that may particularity useful setting prospective multicenter studies childhood-onset where standardized investigators is feasible.