Intravenous thrombolysis and thrombectomy decisions in acute ischemic stroke: An interrater and intrarater agreement study

C. Ducroux, R. Fahed, N.N. Khoury, G. Gevry, E. Kalsoum, M.-A. Labeyrie, D. Ziegler, C. Sauve, M. Chagnon, T.E. Darsaut, J. Raymond
Revue Neurologique. 2019-06-01; 175(6): 380-389
DOI: 10.1016/J.NEUROL.2018.10.005

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1. Rev Neurol (Paris). 2019 Jun;175(6):380-389. doi: 10.1016/j.neurol.2018.10.005.
Epub 2019 Apr 30.

Intravenous thrombolysis and thrombectomy decisions in acute ischemic stroke: An
interrater and intrarater agreement study.

Ducroux C(1), Fahed R(1), Khoury NN(2), Gevry G(3), Kalsoum E(4), Labeyrie MA(5),
Ziegler D(6), Sauve C(6), Chagnon M(7), Darsaut TE(8), Raymond J(9); FAMOUS
collaborative group.

Author information:
(1)Interventional Neuroradiology Department-Fondation Ophtalmologique Adolphe de
Rothschild Hospital, 75019 Paris, France; Radiology Department-Centre Hospitalier
de l’Université de Montréal (CHUM), Notre-Dame Hospital, H2X 3E4 Montreal,
Canada.
(2)HSHS Neuroscience Center – HSHS St. John’s Hospital, 62769 Springfield, IL,
USA.
(3)Radiology Department-Centre Hospitalier de l’Université de Montréal (CHUM),
Notre-Dame Hospital, H2X 3E4 Montreal, Canada.
(4)Neuroadiology Department-Henri Mondor Hospital, 94010 Créteil, France.
(5)Neuroadiology Department-Lariboisière Hospital, 75010 Paris, France.
(6)CHUM Library – Centre Hospitalier de l’Université de Montréal (CHUM),
Notre-Dame Hospital, H2X 3E4 Montreal-Québec, Canada.
(7)Department of Mathematics and Statistic-Université de Montréal, H2X 3E4
Montreal-Québec, Canada.
(8)Department of Surgery, Division of Neurosurgery – University of Alberta
Hospital, Mackenzie Health Sciences Centre, T6G 2B7 Edmonton-Alberta, Canada.
(9)Radiology Department-Centre Hospitalier de l’Université de Montréal (CHUM),
Notre-Dame Hospital, H2X 3E4 Montreal, Canada. Electronic address:
.

PURPOSE: We aimed to assess agreement on intravenous tissue-plasminogen activator
(IV tPA) and mechanical thrombectomy (MT) management decisions in acute ischemic
stroke (AIS) patients. Secondary objectives were to assess agreement on
Diffusion-Weighted-Imaging-Alberta-Stroke-Program-EArly-CT-Score (DWI-ASPECTS),
and clinicians’ willingness to recruit patients in a randomized controlled trial
(RCT) comparing medical management with or without MT.
MATERIALS AND METHODS: Studies assessing agreement of IV tPA and MT were
systematically reviewed. An electronic portfolio of 41 AIS patients was sent to
randomly selected providers at French stroke centers. Raters were asked 4
questions for each case: (1) What is the DWI-ASPECTS? (2) Would you perform IV
tPA? (3) Would you perform MT? (4) Would you include the patient in a RCT
comparing standard medical therapy with or without MT? Twenty responders were
randomly selected to study intrarater agreement. Agreement was assessed using
Fleiss’ Kappa statistics.
RESULTS: The review yielded two single center studies involving 2-5 raters, with
various results. The electronic survey was answered by 86 physicians (60 vascular
neurologists and 26 interventional neuroradiologists). The interrater agreement
was moderate for IV tPA treatment decisions (κ=0.565 [0.420-0.680]), but only
fair for MT (κ=0.383 [0.289-0.491]) and for combined treatment decisions (κ=0.399
[0.320-0.486]). The intrarater agreement was at least substantial for the
majority of raters. The interrater agreement for DWI-ASPECTS was fair (κ=0.325
[0.276-0.387]). Physicians were willing to include a mean of 14±9 patients
(33.1%±21.7%) in a RCT.
CONCLUSION: Disagreements regarding the use of IVtPA or MT in the management of
AIS patients remain frequent. Further trials are needed to resolve the numerous
areas of uncertainty.

Copyright © 2019 Elsevier Masson SAS. All rights reserved.

DOI: 10.1016/j.neurol.2018.10.005
PMID: 31047687 [Indexed for MEDLINE]

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