Towards a consensus-based classification of childhood arterial ischemic stroke

Timothy J. Bernard, Marilyn J. Manco-Johnson, Warren Lo, Mark T. MacKay, Vijeya Ganesan, Gabrielle Deveber, Neil A. Goldenberg, Jennifer Armstrong-Wells, Michael M. Dowling, E. Steve Roach, Mark Tripputi, Heather J. Fullerton, Karen L. Furie, Susanne M. Benseler, Lori C. Jordan, Adam Kirton, Rebecca Ichord

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Background and Purpose-: The implementation of uniform nomenclature and classification in adult arterial ischemic stroke (AIS) has been critical for defining outcomes and recurrence risks according to etiology and in developing risk-stratified treatments. In contrast, current classification and nomenclature in childhood AIS are often overlapping or contradictory. Our purpose was to develop a comprehensive consensus-based classification system for childhood AIS. Methods-: Using a modified-Delphi method, members of the International Pediatric Stroke Study (IPSS) developed the Childhood AIS Standardized Classification And Diagnostic Evaluation (CASCADE) criteria. Two groups of pediatric stroke specialists from the IPSS classified 7 test cases using 2 Methods each: (1) classification typical of the individual clinician's current clinical practice; and (2) classification based on the CASCADE criteria. Group 1 underwent in-person training in the utilization of the CASCADE criteria. Group 2 classified the same cases via an online survey, including definitions but without training. Inter-rater reliability (IRR) was assessed via multi-rater unweighted κ-statistic. Results-: In Group 1 (with training), IRR was improved using CASCADE criteria (κ=0.78, 95% CI=[0.49, 0.94]), compared with typical clinical practice (κ=0.40, 95% CI=[0.11, 0.60]). In Group 2 (without training), IRR was lower than among trained raters (κ=0.61, 95% CI=[0.29, 0.77]), but higher than current practice (κ=0.23, 95% CI=[0.03, 0.36]). Conclusions-: A new, consensus-based classification system for childhood AIS, the CASCADE criteria, can be used to classify cases with good IRR. These preliminary findings suggest that the CASCADE criteria may be particularity useful in the setting of prospective multicenter studies in childhood-onset AIS, where standardized training of investigators is feasible.

Original languageEnglish (US)
Pages (from-to)371-377
Number of pages7
JournalStroke
Volume43
Issue number2
DOIs
StatePublished - Feb 2012

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Stroke
Pediatrics
Terminology
Multicenter Studies
Research Personnel
Prospective Studies
Recurrence

Keywords

  • classification
  • pediatric

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Bernard, T. J., Manco-Johnson, M. J., Lo, W., MacKay, M. T., Ganesan, V., Deveber, G., ... Ichord, R. (2012). Towards a consensus-based classification of childhood arterial ischemic stroke. Stroke, 43(2), 371-377. https://doi.org/10.1161/STROKEAHA.111.624585

Towards a consensus-based classification of childhood arterial ischemic stroke. / Bernard, Timothy J.; Manco-Johnson, Marilyn J.; Lo, Warren; MacKay, Mark T.; Ganesan, Vijeya; Deveber, Gabrielle; Goldenberg, Neil A.; Armstrong-Wells, Jennifer; Dowling, Michael M.; Roach, E. Steve; Tripputi, Mark; Fullerton, Heather J.; Furie, Karen L.; Benseler, Susanne M.; Jordan, Lori C.; Kirton, Adam; Ichord, Rebecca.

In: Stroke, Vol. 43, No. 2, 02.2012, p. 371-377.

Research output: Contribution to journalArticle

Bernard, TJ, Manco-Johnson, MJ, Lo, W, MacKay, MT, Ganesan, V, Deveber, G, Goldenberg, NA, Armstrong-Wells, J, Dowling, MM, Roach, ES, Tripputi, M, Fullerton, HJ, Furie, KL, Benseler, SM, Jordan, LC, Kirton, A & Ichord, R 2012, 'Towards a consensus-based classification of childhood arterial ischemic stroke', Stroke, vol. 43, no. 2, pp. 371-377. https://doi.org/10.1161/STROKEAHA.111.624585
Bernard TJ, Manco-Johnson MJ, Lo W, MacKay MT, Ganesan V, Deveber G et al. Towards a consensus-based classification of childhood arterial ischemic stroke. Stroke. 2012 Feb;43(2):371-377. https://doi.org/10.1161/STROKEAHA.111.624585
Bernard, Timothy J. ; Manco-Johnson, Marilyn J. ; Lo, Warren ; MacKay, Mark T. ; Ganesan, Vijeya ; Deveber, Gabrielle ; Goldenberg, Neil A. ; Armstrong-Wells, Jennifer ; Dowling, Michael M. ; Roach, E. Steve ; Tripputi, Mark ; Fullerton, Heather J. ; Furie, Karen L. ; Benseler, Susanne M. ; Jordan, Lori C. ; Kirton, Adam ; Ichord, Rebecca. / Towards a consensus-based classification of childhood arterial ischemic stroke. In: Stroke. 2012 ; Vol. 43, No. 2. pp. 371-377.
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AU - Ganesan, Vijeya

AU - Deveber, Gabrielle

AU - Goldenberg, Neil A.

AU - Armstrong-Wells, Jennifer

AU - Dowling, Michael M.

AU - Roach, E. Steve

AU - Tripputi, Mark

AU - Fullerton, Heather J.

AU - Furie, Karen L.

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