title: Towards a consensus-based classification of childhood arterial ischemic stroke.
abstract: OBJECTIVE
  The implementation of uniform nomenclature and classification in adult arterial ischemic stroke (AIS) has been critical for defining outcomes and recurrence risks according to etiology and in developing risk-stratified treatments. In contrast, current classification and nomenclature in childhood AIS are often overlapping or contradictory. Our purpose was to develop a comprehensive consensus-based classification system for childhood AIS.
  
  
  METHODS
  Using a modified-Delphi method, members of the International Pediatric Stroke Study (IPSS) developed the Childhood AIS Standardized Classification And Diagnostic Evaluation (CASCADE) criteria. Two groups of pediatric stroke specialists from the IPSS classified 7 test cases using 2 methods each: (1) classification typical of the individual clinician's current clinical practice; and (2) classification based on the CASCADE criteria. Group 1 underwent in-person training in the utilization of the CASCADE criteria. Group 2 classified the same cases via an online survey, including definitions but without training. Inter-rater reliability (IRR) was assessed via multi-rater unweighted κ-statistic.
  
  
  RESULTS
  In Group 1 (with training), IRR was improved using CASCADE criteria (κ=0.78, 95% CI=[0.49, 0.94]), compared with typical clinical practice (κ=0.40, 95% CI=[0.11, 0.60]). In Group 2 (without training), IRR was lower than among trained raters (κ=0.61, 95% CI=[0.29, 0.77]), but higher than current practice (κ=0.23, 95% CI=[0.03, 0.36]).
  
  
  CONCLUSIONS
  A new, consensus-based classification system for childhood AIS, the CASCADE criteria, can be used to classify cases with good IRR. These preliminary findings suggest that the CASCADE criteria may be particularity useful in the setting of prospective multicenter studies in childhood-onset AIS, where standardized training of investigators is feasible.
authors.affiliation: Sections of Child Neurology and Hemophilia and Thrombosis Center, Department of Pediatrics, School of Public Health, University of Colorado, Aurora, CO, USA. timothy.bernard@ucdenver.edu
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bernard
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Manco-Johnson
authors.forename: Warren
authors.initials: W
authors.lastname: Lo
authors.forename: Mark T
authors.initials: MT
authors.lastname: MacKay
authors.forename: Vijeya
authors.initials: V
authors.lastname: Ganesan
authors.forename: Gabrielle
authors.initials: G
authors.lastname: DeVeber
authors.forename: Neil A
authors.initials: NA
authors.lastname: Goldenberg
authors.forename: Jennifer
authors.initials: J
authors.lastname: Armstrong-Wells
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dowling
authors.forename: E Steve
authors.initials: ES
authors.lastname: Roach
authors.forename: Mark
authors.initials: M
authors.lastname: Tripputi
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Fullerton
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Benseler
authors.forename: Lori C
authors.initials: LC
authors.lastname: Jordan
authors.forename: Adam
authors.initials: A
authors.lastname: Kirton
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ichord
mesh_terms: D000465:Algorithms; D002545:Brain Ischemia / Q000145:classification* / Q000150:complications; D002539:Cerebral Arterial Diseases / Q000145:classification* / Q000150:complications; D002648:Child; D032921:Consensus; D003697:Delphi Technique; D006801:Humans; D015588:Observer Variation; D012042:Registries; D015203:Reproducibility of Results; D020521:Stroke / Q000145:classification* / Q000209:etiology