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The Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS): Development and assessment of reliability
Andreas Charidimou1, Anne Schmitt2, Duncan Wilson3
1UCL 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.
Insights
A new tool, the Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS), reliably classifies spontaneous intracerebral haemorrhage (ICH) locations. This aids in understanding ICH causes, risk factors, and prognosis.
Area of Science:
- Neurology
- Radiology
- Medical Informatics
Background:
- Spontaneous intracerebral haemorrhage (ICH) prognosis is influenced by anatomical location (lobar vs. non-lobar).
- Accurate classification of ICH location is crucial for research and clinical applications.
Purpose of the Study:
- To systematically develop and validate a reliable instrument for classifying the anatomical location of spontaneous ICH.
- Introduce the Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS).
Main Methods:
- A two-stage iterative Delphi-style method was employed for instrument development.
- The CHARTS instrument was validated on CT and MRI scans of 227 acute spontaneous symptomatic ICH patients.
- Interrater and intrarater reliability were assessed using kappa statistics.
Main Results:
- The CHARTS instrument demonstrated excellent interrater reliability (kappa > 0.80) for classifying lobar, deep, infratentorial, and uncertain ICH locations.
- Substantial to almost perfect intrarater reliability was observed (kappa = 0.83 and 0.95).
- Reliability remained consistent across individual cerebral lobar regions.
Conclusions:
- The CHARTS instrument provides a reliable and comprehensive method for mapping spontaneous ICH anatomical locations.
- CHARTS can facilitate research into ICH causes, risk factors, and prognosis.
- The instrument may aid in patient stratification for clinical trials.
Purpose:
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.
