Towards a consensus-based classification of childhood arterial ischemic stroke

Area of Science:

• Neurology
• Pediatrics
• Medical Informatics

Background:

• Uniform nomenclature and classification are vital for understanding outcomes and risks in adult arterial ischemic stroke (AIS).
• Current classification systems for childhood AIS are often inconsistent and contradictory.
• A standardized system is needed to improve diagnosis and research in pediatric stroke.

Purpose of the Study:

• To develop a comprehensive, consensus-based classification system for childhood arterial ischemic stroke (AIS).
• To establish standardized diagnostic criteria for pediatric AIS.
• To enhance consistency in research and clinical practice for childhood stroke.

Main Methods:

• The International Pediatric Stroke Study (IPSS) developed the Childhood AIS Standardized Classification And Diagnostic Evaluation (CASCADE) criteria using a modified-Delphi method.
• Two groups of pediatric stroke specialists classified test cases: one group received training on CASCADE criteria, the other did not.
• Inter-rater reliability (IRR) was assessed using the multi-rater unweighted κ-statistic to compare classification methods.

Main Results:

• Trained raters using CASCADE criteria achieved significantly improved inter-rater reliability (κ=0.78) compared to their typical practice (κ=0.40).
• Untrained raters using CASCADE criteria also showed higher IRR (κ=0.61) than those using their typical practice (κ=0.23).
• The CASCADE criteria demonstrated good IRR, even without formal training, suggesting robustness.

Conclusions:

• The consensus-based CASCADE criteria provide a reliable method for classifying childhood AIS.
• These criteria show promise for improving consistency in prospective, multicenter studies of childhood-onset AIS.
• Standardized training in the use of CASCADE criteria can further enhance its utility in pediatric stroke research.