Kristiina Rannikmäe1, Rebecca Woodfield1, Craig S Anderson2, Andreas Charidimou3, Pipat Chiewvit4, Steven M Greenberg5, Jiann-Shing Jeng6, Atte Meretoja7, Frederic Palm8, Jukka Putaala9, Gabriel Je Rinkel10, Jonathan Rosand11, Natalia S Rost12, Daniel Strbian9, Turgut Tatlisumak13, Chung-Fen Tsai14, Marieke Jh Wermer15, David Werring3, Shin-Joe Yeh6, Rustam Al-Shahi Salman1, Cathie Lm Sudlow16. 1. Centre for Clinical Brain Sciences, University of Edinburgh, UK. 2. The George Institute for Global Health, Royal Prince Alfred Hospital and the University of Sydney, Australia. 3. Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, UK. 4. Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. 5. Department of Neurology, Massachusetts General Hospital, USA. 6. Stroke Center and Department of Neurology, National Taiwan University Hospital, Taiwan. 7. Department of Neurology, Helsinki University Central Hospital, Finland Departments of Medicine and the Florey, Royal Melbourne Hospital, University of Melbourne, Australia. 8. Department of Neurology, Städtisches Klinikum Ludwigshafen, Germany. 9. Department of Neurology, Helsinki University Central Hospital, Finland. 10. Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands. 11. Department of Neurology, Massachusetts General Hospital, USA Center for Human Genetic Research, Massachusetts General Hospital, USA Program in Medical and Population Genetics, Broad Institute, USA. 12. Center for Human Genetic Research, Massachusetts General Hospital, USA. 13. Department of Neurology, Helsinki University Central Hospital, Finland Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden Department of Neurology, Sahlgrenska University Hospital, Sweden. 14. Department of Neurology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, Taiwan. 15. Department of Neurology, Leiden University Medical Center, The Netherlands. 16. Centre for Clinical Brain Sciences, University of Edinburgh, UK Institute for Genetics and Molecular Medicine, University of Edinburgh, UK UK Biobank, UK cathie.sudlow@ed.ac.uk.
Abstract
BACKGROUND: Accurately distinguishing non-traumatic intracerebral hemorrhage (ICH) subtypes is important since they may have different risk factors, causal pathways, management, and prognosis. We systematically assessed the inter- and intra-rater reliability of ICH classification systems. METHODS: We sought all available reliability assessments of anatomical and mechanistic ICH classification systems from electronic databases and personal contacts until October 2014. We assessed included studies' characteristics, reporting quality and potential for bias; summarized reliability with kappa value forest plots; and performed meta-analyses of the proportion of cases classified into each subtype. SUMMARY OF REVIEW: We included 8 of 2152 studies identified. Inter- and intra-rater reliabilities were substantial to perfect for anatomical and mechanistic systems (inter-rater kappa values: anatomical 0.78-0.97 [six studies, 518 cases], mechanistic 0.89-0.93 [three studies, 510 cases]; intra-rater kappas: anatomical 0.80-1 [three studies, 137 cases], mechanistic 0.92-0.93 [two studies, 368 cases]). Reporting quality varied but no study fulfilled all criteria and none was free from potential bias. All reliability studies were performed with experienced raters in specialist centers. Proportions of ICH subtypes were largely consistent with previous reports suggesting that included studies are appropriately representative. CONCLUSIONS: Reliability of existing classification systems appears excellent but is unknown outside specialist centers with experienced raters. Future reliability comparisons should be facilitated by studies following recently published reporting guidelines.
BACKGROUND: Accurately distinguishing non-traumatic intracerebral hemorrhage (ICH) subtypes is important since they may have different risk factors, causal pathways, management, and prognosis. We systematically assessed the inter- and intra-rater reliability of ICH classification systems. METHODS: We sought all available reliability assessments of anatomical and mechanistic ICH classification systems from electronic databases and personal contacts until October 2014. We assessed included studies' characteristics, reporting quality and potential for bias; summarized reliability with kappa value forest plots; and performed meta-analyses of the proportion of cases classified into each subtype. SUMMARY OF REVIEW: We included 8 of 2152 studies identified. Inter- and intra-rater reliabilities were substantial to perfect for anatomical and mechanistic systems (inter-rater kappa values: anatomical 0.78-0.97 [six studies, 518 cases], mechanistic 0.89-0.93 [three studies, 510 cases]; intra-rater kappas: anatomical 0.80-1 [three studies, 137 cases], mechanistic 0.92-0.93 [two studies, 368 cases]). Reporting quality varied but no study fulfilled all criteria and none was free from potential bias. All reliability studies were performed with experienced raters in specialist centers. Proportions of ICH subtypes were largely consistent with previous reports suggesting that included studies are appropriately representative. CONCLUSIONS: Reliability of existing classification systems appears excellent but is unknown outside specialist centers with experienced raters. Future reliability comparisons should be facilitated by studies following recently published reporting guidelines.
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