Reliability of intracerebral hemorrhage classification systems: a systematic review

Kristiina Rannikmae, Rebecca Woodfield, Craig Anderson, Andreas Charidimou, Pipat Chiewvit, Steven Greenberg, Jiann-Shing Jeng, Atte Meretoja, Frederick Palm, Jukka Putaala, Gabriël J E Rinkel, Jonathan Rosand, Natalia S Rost, Daniel Strbian, Turgut Tatlisumak, Chung-Fen M. D. Tsai, Marieke J H Wermer, David J. Werring, Shin-Joe Yeh, Rustam SalmanCatherine Sudlow

Research output: Contribution to journalLiterature reviewpeer-review

Abstract / Description of output

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.

Original languageEnglish
Pages (from-to)626-36
Number of pages11
JournalInternational Journal of Stroke
Issue number6
Early online date18 Apr 2016
Publication statusPublished - Aug 2016

Keywords / Materials (for Non-textual outputs)

  • Cerebral Hemorrhage/classification
  • Humans
  • Reproducibility of Results


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