Comparison of the Chinese ischemic stroke subclassification and Trial of Org 10172 in acute stroke treatment systems in minor stroke.
BACKGROUND
The underlying causes of minor stroke are difficult to assess. Here, we evaluate the reliability of the Chinese Ischemic Stroke Subclassification (CISS) system in patients with minor stroke, and compare it to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) system.


METHODS
A total of 320 patients with minor stroke were retrospectively registered and categorized into different subgroups of the CISS and TOAST by two neurologists. Inter- and intra-rater agreement with the two systems were assessed with kappa statistics.


RESULTS
The percentage of undetermined etiology (UE) cases in the CISS system was 77.3 % less than that in the TOAST system, which was statistically significant (P < 0.001). The percentage of large artery atherosclerosis (LAA) in the CISS system was 79.7 % more than that in the TOAST system, which was also statistically significant (P < 0.001). The kappa values for inter-examiner agreement were 0.898 (P = 0.031) and 0.732 (P = 0.022) for the CISS and TOAST systems, respectively. The intra-observer reliability indexes were moderate (0.569 for neurologist A, and 0.487 for neurologist B).


CONCLUSIONS
The CISS and TOAST systems are both reliable in classifying patients with minor stroke. CISS classified more patients into known etiologic categories without sacrificing reliability.
Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, Guangdong, China.
Sha
S
Tan
Department of Neurology, The Fifth Affiliated Hospital of Sun Yat-sen University, No 52 Meihuadong Road, Zhuhai City, China.
Lei
L
Zhang
Department of Neurology, People's Hospital of Zhongshan City, No 2 Sun Yat-sen East Road, Zhongshan City, China.
Xiaoyu
X
Chen
Department of Neurology, Affiliated Hospital of Weifang Medical University, No 465 Yuhe Road, Weifang City, China.
Yanqiang
Y
Wang
Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, Guangdong, China.
Yinyao
Y
Lin
Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, Guangdong, China.
Wei
W
Cai
Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, Guangdong, China.
Yilong
Y
Shan
Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, Guangdong, China.
Wei
W
Qiu
Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, Guangdong, China.
Xueqiang
X
Hu
Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, Guangdong, China. lzq1828@163.com.
Zhengqi
Z
Lu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification* / Q000150:complications / Q000175:diagnosis*
Chinese Ischemic Stroke Subclassification; Diffusion weight imaging; Implications for treatment; Minor stroke; Trial of Org 10172 in Acute Stroke Treatment