London, United Kingdom 2013 15 Management and economics Translation and Central Adjudication of Modified Rankin Scale Assessments in Acute Stroke Trials is Feasible and Reliable. K.S. McArthur1, H. Xing2, J. Dawson3, T.J. Quinn4, P. Higgins5, P. Langhorne6, M.R. Walters7, H. Huang8, K.R. Lees9 for the CARS Investigators Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM1, Dept of Neurology, Peking University First Hospital, Beijing, CHINA2, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM3, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM4, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM5, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM6, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM7, Dept of Neurology, Peking University First Hospi-tal, Beijing, CHINA8, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM9 BACKGROUND The modified Rankin Scale (mRS) is a favoured outcome measure in stroke trials. Residual in-ter- observer variation in mRS assessment, despite training and certification, justifies seeking greater measurement rigour. In the Central Adjudication of mRS assessments in acute stroke (CARS) study we investigated core laboratory scoring of outcomes. International studies add linguistic and cultur-al factors that could influence mRS scoring. We first aimed to assess the validity and reliability of translated mRS assessments. We then explored the practicality of incorporating translations into the central adjudication process. METHODS Trained and certified mRS assessors (n=17) scored digitally recorded mRS assessments (“clips”) of consenting patients. To assess reliability, clips from the UK and China were cross-scored using translated transcripts. To assess feasibility, a sample of CARS clips were also summarised in En-glish, with web-based upload of the revised audio component. Both native language and translated versions of mRS assessments were scored to assess inter-observer (and inter-language) variability. Reliability was described using quadratically weighted(kw) kappa statistics. RESULTS Sixty nine mRS clips were scored with translated transcripts (9 originally English, 60 Mandarin). Inter observer reliability for native (kw0.91 95%CI 0.86-0.96) and translated (kw0.90 95%CI 0.85- 0.95) assessment was identical. In the CARS sample sixty translations were successfully processed via web portal. Inter observer reliability between the original (kw0.88 95% CI 0.78-0.98) and modi-fied (kw0.85 95% CI 0.74-0.95) clips was similar. CONCLUSIONS Inter observer reliability of translated mRS assessment is comparable to previous studies and to na-tive language assessment. Adjudication of translated mRS assessments using either transcripts or re-corded audio is feasible and reliable. Digitally recorded and centrally adjudicated mRS assessments E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 265 may be used in multilingual RCTs. 14 Vascular imaging Comparison of various methods of assessing intracranial collaterals on the pretreatment CT-angiograms to predict outcomes in acute anterior circulation ischemic stroke V.K. Sharma1, H.L. Teoh2, B.P.L. Chan3, E.Y. Ting4, V.F. Chong5, R.C. Seet6, R. Rathakrishnan7, L.L. Yeo8 National University of Singapore, Singapore, SINGAPORE1, National University Health Sys-tem, Singapore, SINGAPORE2, National University Health System, Singapore, SINGAPORE3, National University Health System, Singapore, SINGAPORE4, National University Health System, Singapore, SINGAPORE5, National University of Singapore, Singapore, SINGAPORE6, National University Health System, Singapore, SINGAPORE7, National University Health System, Singa-pore, SINGAPORE8 Background: Effective collateral flow patterns may influence the response to intravenous tissue plas-minogen activator (IV-tPA) in acute ischemic stroke (AIS). We compared the current methods of scoring collaterals on the pre-tPA computed tomographic angiogram (CTA) of brain for prediction of functional outcome in AIS. Methods: Consecutive AIS patients treated with IV-tPA within 4.5 hours of stroke-onset during 2007-2011 were included. Data were collected for demography, risk factors, NIHSS scores and stroke subtypes. Intracranial collaterals were evaluated by 2 independent neuroradiologists by 4 pre-defined criteria- Miteff’s system (middle cerebral artery collateral branches in sylvian fissure); Maas system (collaterals on affected hemisphere versus the other side); modified Tan’s scale (collaterals in 50% or more of the MCA territory classified as good); and 20-point collateral grading scale ac-cording to Alberta Stroke Program Early CT score (ASPECTS) methodology. Good functional out-comes at 3-months were determined by modified Rankin scale (mRS) scores of 0-1. Results: CTA was performed in 115 patients with anterior AIS before IV-tPA. Median age 66yrs (range 35-92), 42% males, median NIHSS 19 points (range 3-30) and median onset-to-treatment time 155 minutes. Overall, 52 (45.2%) patients achieved good functional outcome at 3-months. Uni-variable analysis revealed younger age, absence of diabetes, lower pre-tPA NIHSS scores and good collaterals by ASPECTS method as significantly associated with good functional outcomes. On mul-tivariable logistic regression, only lower NIHSS (OR 1.111 per NIHSS point; 95% CI 1.023-1.206, p=0.013) and good collaterals by ASPECTS method (OR 1.117 per point; 95%CI 1.006-1.241, p=0.039) were found as independent predictors of good outcomes. Conclusion: Of the existing scoring systems for intracranial collaterals, only ASPECTS method serves as a reliable predictor of favorable outcomes in thrombolyzed anterior circulation AIS pa-tients.
Karger_ESC London_2013
To see the actual publication please follow the link above