Hemorrhagic transformation after stroke: Interrater and intrarater agreement - 29/03/19

Doi : 10.1016/j.neurad.2019.01.067

Adrien Guenego, MD ^1,², Augustin Lecler, MD ³, Jean Raymond, MD ⁴, Candice Sabben, MD ⁵, Naim Khoury, MD ⁶, Kevin Premat, MD ¹, Daniele Botta, MD ¹, William Boisseau, MD ¹, Benjamin Maïer, MD ¹, Gabriele Ciccio, MD ¹, Hocine Redjem, MD ¹, Stanislas Smajda, MD ¹, Célina Ducroux, MD ¹, Lucas Di Meglio, MD ⁴, Vincent Davy, MD ⁴, Jean-Marc Olivot, MD PhD ⁷, Adrien Wang, MD ⁸, Julien Duplantier, MD ⁹, Margaux Roques, MD ⁹, Sidney Krystal, MD ³, Patricia Koskas, MD ³, Adrien Collin, MD ³, Malek Ben Maacha ¹⁰, Mylène Hamdani ¹⁰, Kevin Zuber ¹⁰, Raphaël Blanc, MD ¹, Michel Piotin, MD PhD ¹, Robert Fahed, MD ^1,^⁎
for the
ASTER Trial investigators
¹ Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, 29, rue Manin, 75019 Paris, France
² Interventional Neuroradiology Department–Toulouse University Hospital, France
³ Diagnostic Neuroradiology Department–Fondation Ophtalmologique Adolphe de Rothschild Hospital, 75019 Paris, France
⁴ Radiology Department, Centre Hospitalier de l’Université de Montréal, Canada
⁵ Neurology Department, Fondation Ophtalmologique Adolphe de Rothschild Hospital, 75019 Paris, France
⁶ HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL, USA
⁷ Vascular Neurology Department–Toulouse University Hospital, France
⁸ Vascular Neurology Department–Foch Hospital, Suresnes, France
⁹ Diagnostic Neuroradiology Department, Toulouse University Hospital, France
¹⁰ Biostatistics – Fondation Ophtalmologique Adolphe de Rothschild Hospital, 75019 Paris, France

^⁎Corresponding author.

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Résumé

Background

Hemorrhagic transformation (HT) is a complication of stroke [1] that can occur spontaneously or after treatment. We aimed to assess the interrater and intrarater reliability of HT diagnosis.

Methods

Studies assessing the reliability of the European Cooperative Acute Stroke Study (ECASS) classification [2] of HT or of the presence (yes/no) of HT were systematically reviewed. Eighteen raters independently examined 30 post-thrombectomy [3] computed tomography scans selected from the Aspiration versus Stentriever (ASTER) trial [4]. They were asked whether there was HT (yes/no), what the ECASS classification of the particular scan (0/HI1/HI2/PH1/PH2) was, and whether they would prescribe an antiplatelet agent if it was otherwise indicated. Agreement [5] was measured with Fleiss’ and Cohen's kappa statistics.

Results

The systematic review yielded 4 studies involving few (≤3) raters with heterogeneous results. In our 18-rater study, agreement for the presence of HT was moderate (κ=0.55, 95%CI [0.41–0.68]). Agreement for ECASS classification was only fair for all 5 categories, but agreement improved to substantial (k=0.72, 95%CI [0.69-0.75]) after dichotomizing ECASS into 0/HI1/HI2/PH1 versus PH2. The interrater agreement for the decision to reintroduce antiplatelet therapy was moderate for all raters, but substantial among vascular neurologists (κ=0.70 [0.57–0.84]).

Conclusion

The ECASS classification may involve too many categories and the diagnosis of HT may not be easily replicable, except in the presence of a large parenchymal hematoma.

Clinical Trial Registration

URL: www.clinicaltrials.gov/ Unique identifier: NCT02523261.

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Vol 46 - N° 2

P. 71-72 - mars 2019 Retour au numéro

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Hemorrhagic transformation after stroke: Interrater and intrarater agreement - 29/03/19

Résumé

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