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September 1986

Interobserver Agreement in the Diagnosis of Stroke Type

Author Affiliations

From the Biometry and Field Studies Branch, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, Md (Drs Gross and Kunitz and Mss Fishman and Calingo); Ben Gurion University of the Negev, Beer Sheva, Israel (Dr Shinar); New York Neurological Institute, Columbia University, New York (Dr Mohr); Department of Neurology, Michael Reese Hospital and Medical Center, Chicago (Dr Hier); Department of Neurology, Tufts University, Boston (Dr Caplan); Department of Neurology, University of Maryland Hospital and Medical Center, Baltimore (Dr Price); and the Department of Neurology, Boston University Medical Center, Boston (Drs Wolf and Kase).

Arch Neurol. 1986;43(9):893-898. doi:10.1001/archneur.1986.00520090031012

• Interobserver agreement is essential to the reliability of clinical data from cooperative studies and provides the foundation for applying research results to clinical practice. In the Stroke Data Bank, a large cooperative study of stroke, we sought to establish the reliability of a key aspect of stroke diagnosis: the mechanism of stroke. Seventeen patients were evaluated by six neurologists. Interobserver agreement was measured when diagnosis was based on patient history and neurologic examination only, as well as when it was based on results of a completed workup, including a computed tomographic scan. Initial clinical impressions, based solely on history and one neurologic examination, were fairly reliable in establishing the mechanism of stroke (ie, distinguishing among infarcts, subarachnoid hemorrhages, and parenchymatous hemorrhages). Classification into one of nine stroke subtypes was substantially reliable when diagnoses were based on a completed workup. Compared with previous findings for the same physicians and patients, the diagnosis of stroke type was generally more reliable than individual signs and symptoms. These results suggest that multicentered studies can rely on the independent diagnostic choices of several physicians when common definitions are employed and data from a completed workup are available. Furthermore, reliability may be less for individual measurements such as signs or symptoms than for more-complex judgments such as diagnoses.

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