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Inter-Rater Reliability of the CASCADE Criteria: Challenges in Classifying Arteriopathies
Timothy J Bernard1, Lauren A Beslow2, Marilyn J Manco-Johnson2
1From the Section of Child Neurology (T.J.B., J.A.-W., R.B.), Section of Hematology/Oncology/BMT (M.J.M.-J.), Hemophilia and Thrombosis Center, Department of Pediatrics (T.J.B., M.J.M.-J., J.A.-W., A.H.), Department of Pediatrics (T.J.B, M.J.M-J, J.A-W., R.B.), Department of Biostatistics and Informatics, School of Public Health (D.W.), and Department of Neurology (S.P.), University of Colorado, Aurora; Division of Child Neurology (L.A.B.), Department of Pediatrics (L.A.B.), and Department of Neurology (L.A.B.), Yale School of Medicine, New Haven, CT; University of Washington (C.A.L.); Department of Pediatrics (W.L., E.S.R.) and Department of Neurology (W.L., E.S.R.), The Ohio State University and Nationwide Children's Hospital, Columbus; Hospital for Sick Children, University of Toronto, Ontario, Canada (G.d.V.); Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (N.A.G.); All Children's Research Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL (N.A.G.); Division of Pediatric Neurology, Department of Pediatrics (M.M.D.) and Department of Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; Division of Neurology, University of California, San Francisco (H.J.F.); Rheumatology Clinic, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Canada (S.M.B.); Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center (L.C.J.); Calgary Pediatric Stroke Program, Division of Neurology, Alberta Children's Hospital, University of Calgary, Canada (A.K.); and Department Neurology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine (R.N.I.). timothy.bernard@ucdenver.edu.
The CASCADE criteria show moderate reliability for classifying childhood arterial ischemic stroke subtypes. Further refinement is needed for arteriopathic subtypes to improve consistency in research.
Area of Science:
- Pediatric Neurology
- Stroke Classification
- Medical Diagnostics
Background:
- Limited data exist on the reliability of classifying childhood arterial ischemic stroke (AIS) subtypes.
- The International Pediatric Stroke Study (IPSS) developed the CASCADE criteria for standardized classification and evaluation of pediatric AIS.
- Assessing the reliability of the CASCADE criteria is crucial for consistent research and clinical practice.
Purpose of the Study:
- To determine the reliability of the CASCADE criteria in classifying pediatric arterial ischemic stroke subtypes.
- To evaluate inter-rater agreement among experienced raters using the CASCADE criteria.
Main Methods:
- Eight IPSS raters reviewed 64 pediatric AIS cases, classifying them using the CASCADE criteria.
- Data included neuroimaging, clinical history, risk factors, and acute imaging.
- Inter-rater reliability was measured using the unweighted κ statistic.
Main Results:
- The CASCADE criteria demonstrated moderate overall inter-rater reliability (κ = 0.53).
- High agreement was observed for cardioembolic (κ = 0.84) and bilateral cerebral arteriopathy (κ = 0.90) subtypes.
- Lower agreement was found for aortic/cervical arteriopathy (κ = 0.36), unilateral FCA (κ = 0.49), and small vessel arteriopathy (κ = -0.012).
Conclusions:
- The CASCADE criteria possess moderate reliability for use in multicenter pediatric stroke studies by trained raters.
- Further refinement of arteriopathic subtype definitions is necessary to enhance reliability.
- Improved subtype classification can reduce variability in research on childhood stroke risk factors, recurrence, and outcomes.
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