To the Editor.
—We appreciate the thoughtful Editorial of Dr Fisher and colleagues1 on ECASS.2 Their question, "why experienced investigators misinterpreted so many initial CT scans," although provocative, addresses an important aspect of that trial.The ECASS protocol defined clinical and CT inclusion and exclusion criteria to be checked by the local investigators of 75 European study centers and stated that "a panel of 3 independent neuroradiologists will assess all CT scans centrally. It will function as final arbiter. They will double-check and identify eventual exclusion criteria as defined in 3.2 and assess intracranial hemorrhage as defined in Appendix 2."Local monitors gathered all CT scans for submission to the chairman of the CT-Scan Reading Panel who provided the other two members with copies. The members individually and consecutively evaluated all CT scans of the study blinded to any clinical information. The study protocol did not blind their
von Kummer R, Bozzao L. Thrombolysis for Acute Stroke. JAMA. 1996;275(13):984. doi:10.1001/jama.1996.03530370021012