Development and Reliability of a User-Friendly Multicenter Phenotyping Application for Hemorrhagic and Ischemic Stroke

Abstract

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.

APOL1, CDKN2A/CDKN2B, and HDAC9 polymorphisms and small vessel ischemic stroke

“…Stroke diagnosis and phenotyping was undertaken using the ACCESS software [Patent No: NG/PT/NC/2016/2007] based on clinical evaluation and brain neuroimaging (brain CT or MRI). 18 Determination of stroke etiology (large vessel, small vessel, cardioembolic and undetermined) followed a rigorous process of evaluation that included the following investigations in the patient clinically suspected to have had a stroke: neuroimaging (CT/MRI), 12 – lead electrocardiography, echocardiography and carotid doppler ultrasonography. We have eloquently described these in our Methods paper.…”

Advancing stroke genomic research in the age of Trans-Omics big data science: Emerging priorities and opportunities

“…75 African ancestry populations are critically needed for discovery of novel loci associated with stroke and fine-mapping of known loci discovered in American and other populations to pinpoint the precise causal variant(s) and gene(s) and translate to clinical applications. 5, 47 The largest population of (continental) Africans with stroke in a single funded study are included in the Stroke Investigative Research and Education Network (SIREN) study 76 , part of the H3Africa Project, 31, 32, 49 which has >3000 case-control pairs, (with a targeted recruitment of 5000 case-control pairs) accurately phenotyped with the pictographic questionnaire for verification of stroke-free status (pQVSFS) 77, 78 , and ACCESS tool (for standardized phenotyping of ischemic and hemorrhagic strokes) 79, 80 . Cases and controls are comprehensively evaluated for stroke risk factors to ensure appropriate co-variate adjustment.…”

“…Furthermore, the controls, who are recruited from the same catchment population that produced the cases are matched for age, sex and ethnicity to minimize confounding due to population structure. 2, 5, 44, 76–79 . Preliminary data (n=917) from candidate gene studies (24 SNPs) in SIREN show that the IL-6 rs1800796 was significantly associated with ischemic stroke in West African men (OR = 2.006, 95% CI = [1.065, 3.777].…”

Biobanking in a Challenging African Environment: Unique Experience from the SIREN Project

“…In addition, the SIREN team has developed a neuroimaging databank, the Annotation and Image Markup on Clear Canvas Enriched Stroke–phenotyping Software (ACCESS). 20 This is a novel standalone computer software application that allows the creation of simple standardized annotations for reporting brain images of all stroke types. The ACCESS application facilitates a concordant and reproducible classification of stroke subtypes by multiple investigators, thus making it suitable for clinical use and multicenter research ( Fig.…”

“… 22 SIREN, as a member of the H3Africa Consortium, is banking her biospecimens with the H3Africa central biorepository. Accessing these biospecimens follows the guidelines stipulated by the H3Africa Data and Biospecimen Access Committee Guidelines, which are eloquently described in the cited article by Beiswanger et al 20 Briefly, a non-H3Africa investigator who meets stipulated criteria can send a request to the H3Africa Secretariat. This request will be forwarded to the Data and Biospecimen Access Committee for necessary considerations.…”