title: The Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS): Development and assessment of reliability.
abstract: OBJECTIVE
  The causes, risk factors and prognosis of spontaneous intracerebral haemorrhage (ICH) are partly determined by anatomical location (specifically, lobar vs. non-lobar (deep and infratentorial) regions). We systematically developed a rating instrument to reliably classify ICH location.
  
  
  METHODS
  We used a two-stage iterative Delphi-style method for instrument development. The resultant Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS) was validated on CT and MRI scans from a cohort of consecutive patients with acute spontaneous symptomatic ICH by three independent raters. We tested interrater and intrarater reliability using kappa statistics.
  
  
  RESULTS
  Our validation cohort included 227 patients (58% male; median age: 72.4 (IQR: 67.1-74.6)). The interrater reliability for the main analyses (i.e. including any lobar ICH; all deep and infratentorial anatomical categories (lentiform, caudate thalamus; brainstem; cerebellum); and uncertain location) was excellent (all kappa values>0.80) both in pair-wise between-rater comparisons and across all raters. The intrarater reliability was substantial to almost perfect (k=0.83; 95%CI: 0.77-0.88 and k=0.95; 95%CI: 0.92-0.96 respectively). All kappa statistics remained consistent for individual cerebral lobar regions.
  
  
  CONCLUSIONS
  The CHARTS instrument can be used to reliably and comprehensively map the anatomical location of spontaneous ICH, and may be helpful for studying important questions regarding causes, risk factors, prognosis, and for stratification in clinical trials.
authors.affiliation: UCL Stroke Research Centre, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Hemorrhagic Stroke Research Group, Harvard Medical School, Massachusetts General Hospital, Boston, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Charidimou
authors.affiliation: Lysholm Department of Neuroradiology, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Schmitt
authors.affiliation: UCL Stroke Research Centre, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
authors.forename: Duncan
authors.initials: D
authors.lastname: Wilson
authors.affiliation: UCL Stroke Research Centre, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yakushiji
authors.affiliation: UCL Stroke Research Centre, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
authors.forename: Simone M
authors.initials: SM
authors.lastname: Gregoire
authors.affiliation: Biomedical Research Centre, Education Unit, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Hemorrhagic Stroke Research Group, Harvard Medical School, Massachusetts General Hospital, Boston, USA.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Fox
authors.affiliation: UCL Stroke Research Centre, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Lysholm Department of Neuroradiology, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Hans R
authors.initials: HR
authors.lastname: Jäger
authors.affiliation: UCL Stroke Research Centre, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. Electronic address: d.werring@ucl.ac.uk.
authors.forename: David J
authors.initials: DJ
authors.lastname: Werring
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D001931:Brain Mapping; D002543:Cerebral Hemorrhage / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology*; D015331:Cohort Studies; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed
keywords: CT; Cerebral amyloid angiopathy; Intracerebral haemorrhage; MRI; Stroke