Agreement between TOAST and CCS ischemic stroke classification: The NINDS SiGN Study

On Behalf Of The Ninds SiGN Study

doi:10.1212/WNL.0000000000000942

Agreement between TOAST and CCS ischemic stroke classification: The NINDS SiGN Study

On Behalf Of The Ninds SiGN Study

Neurology

University of Maryland, Baltimore
University of Maryland, College Park
Harvard University
Mayo Clinic Rochester, MN
University of Miami
Albert Einstein College of Medicine
University of Cincinnati
The Broad Institute of MIT and Harvard
University of Alabama at Birmingham
National Institutes of Health
Utrecht University
Netherlands; Institute for Stroke and Dementia Research
Ludwig Maximilian University of Munich
Munich Cluster for Systems Neurology (SyNergy)
Saint Francis Medical Center
University of Gothenburg
IMIM-Hospital Universitari Del Mar
Medical University of Graz
Flanders Institute for Biotechnology
Leuven Research Institute for Neuroscience and Disease (LIND)
KU Leuven
University of Oxford
Lund University
St. George's Hospital Medical School
Jagiellonian University Medical College
John Radcliffe Hospital
University of Edinburgh
University of Virginia

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

66 Scopus citations

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%; k = 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 (k = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (k = 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)	1653-1660
Number of pages	8
Journal	Neurology
Volume	83
Issue number	18
DOIs	https://doi.org/10.1212/WNL.0000000000000942
State	Published - Oct 1 2014

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10.1212/WNL.0000000000000942

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@article{1705512ab9fa48cb9763c304d1284a79,

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

author = "\{On Behalf Of The 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 Cathie Sudlow and Vincent Thijs and Steffen Tiedt and Raffaella Valenti and Worrall, \{Bradford B.\}",

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

year = "2014",

month = oct,

day = "1",

doi = "10.1212/WNL.0000000000000942",

language = "English",

volume = "83",

pages = "1653--1660",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams and Wilkins",

number = "18",

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TY - JOUR

T1 - Agreement between TOAST and CCS ischemic stroke classification

T2 - The NINDS SiGN Study

AU - On Behalf Of The 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, Cathie

AU - Thijs, Vincent

AU - Tiedt, Steffen

AU - Valenti, Raffaella

AU - Worrall, Bradford B.

PY - 2014/10/1

Y1 - 2014/10/1

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

UR - https://www.scopus.com/pages/publications/84922392515

U2 - 10.1212/WNL.0000000000000942

DO - 10.1212/WNL.0000000000000942

M3 - Article

C2 - 25261504

AN - SCOPUS:84922392515

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

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