Document Detail

Validation of the Oxfordshire Community Stroke Project syndrome diagnosis derived from a standard symptom list in acute stroke.
MedLine Citation:
PMID:  15140606     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The Oxfordshire Community Stroke Project (OCSP) classification allows distinction of stroke subtypes with different prognosis. OCSP classification inferred from clinical signs filled out on patient entry forms has been used to facilitate subgroup analysis in clinical trials. However, such procedure has not been validated against clinical diagnosis. In preparation for an acute stroke trial, we set out to perform such a validation. METHODS: An OCSP syndrome diagnosis of 194 acute stroke patients in four hospitals was made within 24 h using a standard list with neurological signs, to be filled out by a stroke physician or neurological resident on duty. This was compared with OCSP diagnosis within 2 days of stroke onset by a (blinded) stroke neurologist ("gold standard"). RESULTS: The proportion of the OCSP syndromes was quite similar between standard list and clinical judgement. Sensitivity, specificity, positive and negative predictive values were respectively: LACS: 0.76, 0.88, 0.72, 0.90; TACS: 0.63, 0.93, 0.62, 0.88; PACS: 0.62, 0.76, 0.63, 0.75; POCS: 0.50, 0.98, 0.60, 0.97. Kappa for agreement was 0.63 (LACS), 0.37 (PACS), 0.50 (TACS). Neuro-imaging falsified stroke subtype diagnosis in 40 cases (20.6%) diagnosed using the standard list, and 42 (21.6%) diagnosed by stroke neurologists. CONCLUSION: A standard list-derived stroke syndrome diagnosis may be used as a clinical test to make an OCSP syndrome diagnosis in acute stroke. The use of such list in acute stroke trials may facilitate uniformity in early stroke subtype diagnosis. However, to increase such uniformity, ancillary methods such as acute MRI should be evaluated.
Leo Aerden; Gert-Jan Luijckx; Stefano Ricci; Anne Hilton; Fons Kessels; Jan Lodder
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Validation Studies    
Journal Detail:
Title:  Journal of the neurological sciences     Volume:  220     ISSN:  0022-510X     ISO Abbreviation:  J. Neurol. Sci.     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-05-13     Completed Date:  2004-07-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0375403     Medline TA:  J Neurol Sci     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  55-8     Citation Subset:  IM    
Department of Neurology, Atrium Medisch Centrum, Heerlen, The Netherlands.
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MeSH Terms
Aged, 80 and over
Diagnostic Techniques and Procedures*
Middle Aged
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Severity of Illness Index*
Stroke / classification*,  diagnosis*,  epidemiology

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