Inter-rater reliability of the simplified Modified Rankin Scale as an outcome measure for treated cerebral aneurysm patients.

BACKGROUND: The modified Rankin scale (mRS) is commonly used as a clinical outcome measure in aneurysm trials, but inter-observer reliability in treated patients has not been tested. METHODS: We reviewed the literature on inter-observer reliability studies of the mRS. Sixty patients with ruptured (n=47) or unruptured (n=13) aneurysms treated with endovascular methods (n=34) or surgical clipping (n=26) were independently evaluated by a neurosurgeon, a stroke neurologist, and a novice research assistant, and a simplified mRS score assigned. Results were analyzed using Gwet's AC1/2 reliability coefficients (KG). RESULTS: No previous reports validating the reliability of the mRS in treated aneurysm patients were identified. Using the mRS 0-5, inter-rater agreement was almost perfect (KG=0.89 [0.86-0.93]). Agreement between raters remained almost perfect regardless of the rater's expertise. Agreement was almost perfect (KG=0.87 [0.77-0.96] when the mRS was dichotomized 0-2 vs 3-5, but fell to moderate when dichotomized 0-1 vs 2-5 (KG=0.59 (0.42-0.75). Agreement using the 0-2 vs 3-5 dichotomized mRS remained almost perfect for coiled (KG=0.90), clipped (KG=0.82), ruptured (KG=0.84), and unruptured (KG=0.95) aneurysms. Dichotomization of results at 0-1 vs 2-5 would have resulted in an (undesirable) significant difference in good outcomes between raters (P=.003), but not at 0-2 vs 3-5 (P=.52). CONCLUSION: The simplified mRS appears to be a reliable clinical outcome measure for treated cerebral aneurysm patients. When needed, dichotomization is more reliable at mRS 0-2 vs 3-5 than at 0-1 vs 2-5. The simplified mRS is a promising tool in the functional assessment of aneurysm patients recruited in pragmatic care trials.

Loss of HLA-A,B,C and de novo expression of HLA-D in colorectal cancer.

One hundred primary colorectal carcinomas and 19 metastases were studied for the expression of HLA-A,B,C and HLA-D antigens using monoclonal antibodies (MAbs) against framework determinants and a sensitive immunoperoxidase technique on frozen sections. With MAb W6/32, 65 tumors were intensely stained for HLA-A,B,C; 22 showed a reduced staining intensity, in 5 carcinomas a minor or major subset of the tumor cells lacked HLA-A,B,C, and in 8 cases all tumor cells were unreactive. The loss of HLA-A,B,C was inversely correlated with the degree of differentiation. No relation was found to type, stage and site of the tumor, or to age and sex of the patients. With MAb 2.06, 58 tumors were HLA-D negative, 20 exhibited small positive foci, 19 showed a patchy staining pattern, and 3 were homogeneously HLA-D positive. There was no apparent correlation between HLA-D expression and any of the clinico-pathological features mentioned, nor was it related to the loss of HLA-A,B,C. About half of the metastases displayed the same staining pattern for HLA-A,B,C and -D as the respective primary tumors. The remainder differed from the primary carcinoma by gain or loss of HLA antigens.