eCite Digital Repository
Validation of a clinical classification for subtypes of acute cerebral infarction
Citation
Anderson, CS and Taylor, BV and Hankey, GJ and Stewart-Wynne, EG and Jamrozik, KD, Validation of a clinical classification for subtypes of acute cerebral infarction, Journal of Neurology, Neurosurgery and Psychiatry, 57, (10) pp. 1173-1179. ISSN 0022-3050 (1994) [Refereed Article]
DOI: doi:10.1136/jnnp.57.10.1173
Abstract
The validity of a clinical classification
system was assessed for subtypes of cerebral
infarction for use in clinical trials of
putative stroke therapies and clinical
decision making in a population based
stroke register (n = 536) compiled in
Perth, Western Australia in 1989-90. The
Perth Community Stroke Project (PCSS)
used definitions and methodology similar
to the Oxfordshire Community Stroke
Project (OCSP) where the classification
system was developed. In the PCSS, 421
cases of cerebral infarction and primary
intracerebral haemorrhage (PICH), confirmed
by brain imaging or necropsy,
were classified into the subtypes total
anterior circulation syndrome (TACS),
partial anterior circulation syndrome
(PACS), lacunar syndrome (LACS), and
posterior circulation syndrome (POCS).
In this relatively unselected population,
relying exclusively on LACS for a diagnosis
of PICH had a very low sensitivity
(6%) and positive predictive value (3%).
Comparison of the frequencies and outcomes
(at one year after the onset of
symptoms) for each subgroup of first
ever cerebral infarction in the PCSS (n =
248) with the OCSP (n = 543) registers
showed uniformity only for LACI. For
example, there were 27% of cases of
TACI in the PCSS compared with 17% in
the OCSP (difference = 10%; 95% confidence
interval (95% CI) 4% to 16%) and
15% of cases in the PCSS compared with
24% in the OCSP were POCI (difference
= 9%; 95% CI 3% to 15%). Case fatalities
and long term handicap across the subgroups
were not significantly different
between studies, but the frequencies of
recurrent stroke were significantly
greater for POCI in the OCSP compared
with the PCSS. Although this classification
system defines subtypes of stroke
with different outcomes, simple clinical
measures-level of consciousness, paresis,
disability, and incontinence at
onset-are more powerful predictors of
death or dependency at one year. It is
concluded that simple clinical measures
that reflect the severity of the neurological
deficit should complement this classification
system in clinical trials and
practice.
Item Details
Item Type: | Refereed Article |
---|---|
Research Division: | Biomedical and Clinical Sciences |
Research Group: | Neurosciences |
Research Field: | Central nervous system |
Objective Division: | Health |
Objective Group: | Clinical health |
Objective Field: | Clinical health not elsewhere classified |
UTAS Author: | Taylor, BV (Professor Bruce Taylor) |
ID Code: | 71726 |
Year Published: | 1994 |
Web of Science® Times Cited: | 57 |
Deposited By: | Menzies Institute for Medical Research |
Deposited On: | 2011-08-03 |
Last Modified: | 2011-08-03 |
Downloads: | 0 |
Repository Staff Only: item control page