Background
AIM on ClearCanvas Enriched Stroke- phenotyping Software (ACCESS) is a novel standalone computer software application that allows creation of simple standardized annotations for reporting brain images of all stroke types. We developed the ACCESS application and determined its inter-rater and intra-rater reliability in the Stroke Investigative Research and Educational Network (SIREN) study to assess its suitability for multicenter studies.
Methods
One hundred randomly selected stroke imaging reports from five SIREN sites were reevaluated by four trained independent raters to determine inter-rater reliability of ACCESS (version 12.0) software for stroke phenotyping. To determine intra-rater reliability, six raters reviewed the same cases previously reported by them after a month interval. Ischemic stroke was classified using the Oxfordshire Community Stroke Project (OCSP), TOAST and ASCO protocols, while hemorrhagic stroke was classified using the SMASH-U protocol in ACCESS. Agreement among raters was measured with Cohen’s kappa statistics.
Results
For primary stroke type, inter-rater agreement was 0.98 (95%CI: 0.94–1.00) while intra-rater agreement was 1.00 (95%CI: 1.00). For OCSP subtypes, inter-rater agreement was 0.97 (95%CI: 0.92–1.00) for the Partial Anterior Circulation Infarcts (PACI), 0.92 (95%CI: 0.76–1.00) for the Total Anterior Circulation Infarcts(TACI) and excellent for both Lacunar Infarct (LACI) and Posterior Circulation Infarcts (POCI). Intra-rater agreement was 0.97 (0.90–1.00) while inter-rater agreement was 0.93 (95%CI: 0.84–1.00) for TOAST subtypes. Inter-rater agreement ranged between 0.78 (cardioembolic) to 0.91 (large artery atherosclerotic) for ASCO subtypes and was 0.80 (95%CI: 0.56–1.00) for SMASH-U subtypes.
Conclusion
The ACCESS application facilitates concordant and reproducible classification of stroke subtypes by multiple investigators, making it suitable for clinical and multicenter research.
BACKGROUND: The hand is a very vital part of the human body in structure and function. Injuries to the hand can be very devastating affecting individual and national productivity because of inability of the usually active workforce to use their hands adequately. This study is therefore, to document the pattern of hand injuries and the disabilities from such injuries in our environment.METHODOLOGY: This was a retrospective review of patients who presented and were managed for hand injuries at the outpatient clinics of two tertiary hospitals in Delta State of Nigeria between January 2013 and December 2015. The admission and operation registers as well as case notes of patients treated at the units were the sources of the information. Ethical approval was obtained from the Ethics committee of the Teaching Hospital. The results were analysed using SPSS version 20. Descriptive statistics were used to represent frequency distribution. RESULTS: A total of 102 patients were managed in the 2 tertiary hospitals in the state in the study period. 63.7% were males and 36.3% females. The age range most commonly affected was the 20 – 29 years (35.3%) followed by 30 – 39 years and 10 – 19 years at 15.7% each. Majority were students (38.2%) followed by civil servants (19.6%). Commercial motorcyclists, artisans and machinery operators lumped together made up 15.7%. The commonest cause of injury was machete/ knife cuts and stab wounds (24.5%), followed by RTA (20.6%), burns (14.7%) and machinery accidents (13.7%). On the types of injuries sustained, deep lacerations (injuring tendons and nerves) were the commonest (33.3%). Contractures secondary to burn injuries were next (13.7%) whereas, 11.8% had crush injuries as well as another 11.8% with fractures/ dislocations. 61.8% of patients had good outcomes following treatment while 38.2% had outcomes adjudged as poor or fair.CONCLUSION: Hand injuries are disabling and may deny the citizenry and the nation of useful workforce and productivity. Hand trauma can be prevented by encouraging civil societies and providing safe home and workplace environments. KEY WORDS: Burden; pattern; hand injuries; disabilities.
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