Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study

NINDS SiGN Study; Patrick F McArdle; Steven J Kittner; Hakan Ay; Robert D Brown; James F Meschia; Tatjana Rundek; Sylvia Wassertheil-Smoller; Daniel Woo; Gunnar Andsberg; Alessandro Biffi; David A Brenner; John W Cole; Roderick Corriveau; Paul I W de Bakker; Hossein Delavaran; Martin Dichgans; Raji P Grewal; Katrina Gwinn; Mohammed Huq; Christina Jern; Jordi Jimenez-Conde; Katarina Jood; Robert C Kaplan; Petra Katschnig; Michael Katsnelson; Daniel L Labovitz; Robin Lemmens; Linxin Li; Arne Lindgren; Hugh S Markus; Leema R Peddareddygari; Annie Pedersén; Joanna Pera; Petra Redfors; Jaume Roquer; Jonathan Rosand; Natalia S Rost; Peter M Rothwell; Ralph L Sacco; Pankaj Sharma; Agnieszka Slowik; Catherine Sudlow; Vincent Thijs; Steffen Tiedt; Raffaella Valenti; Bradford B Worrall

doi:10.1212/WNL.0000000000000942

Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study

NINDS SiGN Study, Patrick F McArdle, Steven J Kittner, Hakan Ay, Robert D Brown, James F Meschia, Tatjana Rundek, Sylvia Wassertheil-Smoller, Daniel Woo, Gunnar Andsberg, Alessandro Biffi, David A Brenner, John W Cole, Roderick Corriveau, Paul I W de Bakker, Hossein Delavaran, Martin Dichgans, Raji P Grewal, Katrina Gwinn, Mohammed HuqChristina Jern, Jordi Jimenez-Conde, Katarina Jood, Robert C Kaplan, Petra Katschnig, Michael Katsnelson, Daniel L Labovitz, Robin Lemmens, Linxin Li, Arne Lindgren, Hugh S Markus, Leema R Peddareddygari, Annie Pedersén, Joanna Pera, Petra Redfors, Jaume Roquer, Jonathan Rosand, Natalia S Rost, Peter M Rothwell, Ralph L Sacco, Pankaj Sharma, Agnieszka Slowik, Catherine Sudlow, Vincent Thijs, Steffen Tiedt, Raffaella Valenti, Bradford B Worrall

Research output: Contribution to journal › Article › peer-review

Abstract

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%; κ = 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 (κ = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (κ = 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.

Original language	English
Pages (from-to)	1653-60
Number of pages	8
Journal	Neurology
Volume	83
Issue number	18
DOIs	https://doi.org/10.1212/WNL.0000000000000942
Publication status	Published - 28 Oct 2014

Keywords / Materials (for Non-textual outputs)

Adult
Aged
Aged, 80 and over
Brain Ischemia
Diagnostic Techniques and Procedures
Europe
Female
Humans
Male
Middle Aged
National Institute of Neurological Disorders and Stroke
Phenotype
Stroke
United States

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10.1212/WNL.0000000000000942

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NINDS SiGN Study, McArdle, P. F., Kittner, S. J., Ay, H., Brown, R. D., Meschia, J. F., Rundek, T., Wassertheil-Smoller, S., Woo, D., Andsberg, G., Biffi, A., Brenner, D. A., Cole, J. W., Corriveau, R., de Bakker, P. I. W., Delavaran, H., Dichgans, M., Grewal, R. P., Gwinn, K., ... Worrall, B. B. (2014). Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study. Neurology, 83(18), 1653-60. https://doi.org/10.1212/WNL.0000000000000942

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title = "Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study",

abstract = "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%; κ = 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 (κ = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (κ = 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.",

keywords = "Adult, Aged, Aged, 80 and over, Brain Ischemia, Diagnostic Techniques and Procedures, Europe, Female, Humans, Male, Middle Aged, National Institute of Neurological Disorders and Stroke, Phenotype, Stroke, United States",

author = "{NINDS SiGN Study} and McArdle, {Patrick F} and Kittner, {Steven J} and Hakan Ay and Brown, {Robert D} and Meschia, {James F} and Tatjana Rundek and Sylvia Wassertheil-Smoller and Daniel Woo and Gunnar Andsberg and Alessandro Biffi and Brenner, {David A} and Cole, {John W} and Roderick Corriveau and {de Bakker}, {Paul I W} and Hossein Delavaran and Martin Dichgans and Grewal, {Raji P} and Katrina Gwinn and Mohammed Huq and Christina Jern and Jordi Jimenez-Conde and Katarina Jood and Kaplan, {Robert C} and Petra Katschnig and Michael Katsnelson and Labovitz, {Daniel L} and Robin Lemmens and Linxin Li and Arne Lindgren and Markus, {Hugh S} and Peddareddygari, {Leema R} and Annie Peders{\'e}n and Joanna Pera and Petra Redfors and Jaume Roquer and Jonathan Rosand and Rost, {Natalia S} and Rothwell, {Peter M} and Sacco, {Ralph L} and Pankaj Sharma and Agnieszka Slowik and Catherine Sudlow and Vincent Thijs and Steffen Tiedt and Raffaella Valenti and Worrall, {Bradford B}",

note = "{\textcopyright} 2014 American Academy of Neurology.",

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doi = "10.1212/WNL.0000000000000942",

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NINDS SiGN Study, McArdle, PF, Kittner, SJ, Ay, H, Brown, RD, Meschia, JF, Rundek, T, Wassertheil-Smoller, S, Woo, D, Andsberg, G, Biffi, A, Brenner, DA, Cole, JW, Corriveau, R, de Bakker, PIW, Delavaran, H, Dichgans, M, Grewal, RP, Gwinn, K, Huq, M, Jern, C, Jimenez-Conde, J, Jood, K, Kaplan, RC, Katschnig, P, Katsnelson, M, Labovitz, DL, Lemmens, R, Li, L, Lindgren, A, Markus, HS, Peddareddygari, LR, Pedersén, A, Pera, J, Redfors, P, Roquer, J, Rosand, J, Rost, NS, Rothwell, PM, Sacco, RL, Sharma, P, Slowik, A, Sudlow, C, Thijs, V, Tiedt, S, Valenti, R & Worrall, BB 2014, 'Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study', Neurology, vol. 83, no. 18, pp. 1653-60. https://doi.org/10.1212/WNL.0000000000000942

TY - JOUR

T1 - Agreement between TOAST and CCS ischemic stroke classification

T2 - the NINDS SiGN study

AU - 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, Catherine

AU - Thijs, Vincent

AU - Tiedt, Steffen

AU - Valenti, Raffaella

AU - Worrall, Bradford B

PY - 2014/10/28

Y1 - 2014/10/28

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%; κ = 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 (κ = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (κ = 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%; κ = 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 (κ = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (κ = 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Brain Ischemia

KW - Diagnostic Techniques and Procedures

KW - Europe

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - National Institute of Neurological Disorders and Stroke

KW - Phenotype

KW - Stroke

KW - United States

U2 - 10.1212/WNL.0000000000000942

DO - 10.1212/WNL.0000000000000942

M3 - Article

C2 - 25261504

SN - 0028-3878

VL - 83

SP - 1653

EP - 1660

JO - Neurology

JF - Neurology

IS - 18

ER -

Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study

Abstract

Keywords / Materials (for Non-textual outputs)

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