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PubMed1998

NICE, a new cause of death classification for stillbirths and neonatal deaths. Neonatal and Intrauterine Death Classification according to Etiology.

BACKGROUND: Stillbirths and neonatal deaths are often the result of a complicated chain of events. For epidemiological purposes a classification into single cause of death groups is essential. For large-scale studies, a method is needed which enables such grouping based on available register data. METHODS: A cause of death classification system called NICE is presented. It is hierarchical and is aetiologically orientated. A computerized method is adapted which makes use of data in four central Swedish registries. A validation of the computer method has been made from the medical records on a 10% sample of all stillbirths and neonatally dead infants in Sweden from 1983 to 1990. RESULTS: The specificity of the computer method is high, sensitivity is less satisfactory for some subgroups. A time trend analysis illustrates the usefulness of the classification system and shows a decline with time for two groups: placental abruption and obstetric complications. CONCLUSIONS: The NICE classification system fulfils the criteria of an aetiologically orientated classification system which can be used in a computerized environment.

Cause of Death↗
PubMed1999

The revised European-American Classification of Lymphoid Neoplasms (REAL): a preferred approach for the classification of cutaneous lymphomas.

The Revised European-American Classification of Lymphoid Neoplasms (REAL) classification is based on the principle that each type of lymphoma is a distinct disease defined by morphology, immunophenotypic and genetic features, clinical presentation, and course. If either primary or secondary involvement of the skin is a constant factor, this aspect is considered integral to disease definition. Organ-specific classification schemes, such as that proposed by the European Organization for Research and Treatment of Cancer (EORTC) for cutaneous lymphomas, are not required, and indeed may impede the recognition of common features of diseases involving multiple anatomic sites. The use of multiple classification systems is a step backward, and may lead to confusion among hematologists/oncologists and dermatologists. Nevertheless, cutaneous lymphomas in many instances are distinct. Their natural history is often more indolent than nodal lymphomas, and for that reason they often require different therapeutic approaches. We agree with the efforts of the EORTC classification to emphasize the unique clinical aspects of many cutaneous lymphomas, as this recognition is essential for appropriate clinical management. As has been learned for nodal lymphomas, clinical features play an important role in prognosis and should be used in guiding therapy. For cutaneous lymphomas, the presence or absence of systemic spread is particularly important.

Hodgkin Disease↗
PubMed2001

Classification of chronic radiation sickness cases using neural networks and classification trees.

Chronic radiation sickness is a deterministic radiation health effect observed among the Mayak Production Association workers in Russia. In this study, unsupervised neural networks were used to cluster hematological measurements in a subset (n = 88) of the Mayak Production Association population while excluding from the analysis the radiation dose and the historical clinical diagnosis. Clusters of observations that had lower average leukocyte and thrombocyte counts were labeled "affected" and those having higher average blood cell counts were labeled "unaffected." The class (cluster) membership for each individual was used subsequently as a dependent variable in a classification tree model in order to identify significant features of the underlying classification model. After re-classification of cases using this method, the results showed a better data separation between the blood cell counts for affected vs. unaffected groups compared to those based on historical classification, and a greater difference between group means for differential blood counts was observed than for the historical diagnosis. The reclassification of diagnostic groups changed the group mean radiation doses. The geometric means (and 95% CL) of cumulative radiation dose equivalent from external exposures, based on the historical diagnosis, are 0.31 (0.0035, 3.4) vs. 1.7 (0.0007, 18) Sv. After clustering and classification tree analyses, the group geometric means were 0.78 (0.0014, 8.6) vs. 1.5 (0.0007, 17) and 0.82 (0.0013, 9.0) vs. 1.4 (0.0008, 16) Sv, using (respectively) whole blood cell counts or differential counts as the independent variables. The approach presented here is useful as a diagnostic aid for both retrospective analyses and in the event of future radiation accidents.

Chronic Disease↗
PubMed1999

Classification of the epilepsies: time for a change? A critical review of the International Classification of the Epilepsies and Epileptic Syndromes (ICEES) and its usefulness in clinical practice and epidemiological studies of epilepsy.

The Commission on Classification and Terminology of the International League against Epilepsy (ILAE) first devised a comprehensive classification for the epilepsies and epileptic syndromes nearly 30 years ago. Despite subsequent revisions, the classification remains too complicated to be of utility in clinical practice and epidemiological research. Recent developments in neuro-imaging and neurogenetics have also contributed to the limited usefulness of the current International Classification of the Epilepsies and Epileptic Syndromes (ICEES). This review examines the evolution, advantages, and notable disadvantages of the ICEES and assesses its previous application in several population-based studies of epilepsy. The important need for a new, simplified, and aetiologically orientated classification which is amenable to use outside of the tertiary epilepsy centre is discussed.

Epidemiologic Methods↗
PubMed1977

[Comparison of descriptive expressions between ILO U/C international classification of radiographs of pneumoconiosis 1971 and Japanese classification of pneumoconiosis law in Japan 1960 in pulmonary asbestosis (author's transl)].

In the explanatory text of the ILO U/C International classification of Radiographs of Pneumoconiosis (1971) sent to Japan in 1973, items of its expression on pulmonary asbestosis were analyzed by the author. On the other hand, items of Japanese Asbestosis Classification of Pneumoconiosis Law were also analyzed. The ILO U/C International Classification of Radiographs of Pneumoconiosis (1971) have some confused words. As to pulmonary asbestosis, an expression of irregular opacities is used, but the fundamental X-ray opacities such as linear opacities are forgot in the description. The X-ray findings of the pulmonary asbestosis are divided into 3 types as s, t and u. It is, however, difficult in practice to divide X-ray findings of the pulmonary asbestosis into such types. The classification of X-ray findings of the pulmonary asbestosis in the Japanese Pneumoconiosis Law is based on the classification worked out by many investigators i; the past, providing for simplicity and ease of handling.

Aged↗
PubMed1983

[Histological classification of oral leukoplakia by a classification number].

From 1969 to 1980 the authors examined 587 histological specimens of oral leukoplakia obtained from 424 patients. The histological findings were assessed in classification numbers qualitatively and quantitatively characterizing the subepithelial inflammation, epithelial hyperplasia, keratosis, the grade of epithelial dysplasia an the degree of infiltration when carcinoma had already developed. From this histological classification a classification number resulted which allows conclusions on the prognosis of the leukoplakia under study. Besides the grade of dysplasia also the features of the subepithelial inflammation are important for the prognostic assessment of leukoplakia. The classification numbers are suitable for data processing. In the grading system reported, the most important morphological findings are represented with qualitative and quantitative objectiveness. The classification number leads to more reliable comparison and evaluation of the results obtained by different research groups.

Female↗
PubMedDate not supplied

Comparison of lateral pillar classification and Catterall classification of Legg-Calvé-Perthes' disease.

To compare the predictive value of the Herring lateral pillar and the Catterall classifications of Legg-Calvé-Perthes' disease, 71 hips with radiographic follow-up to maturity were reviewed. The Herring classification was a significantly better predictor of Stulberg outcome than the Catterall classification. Three independent observers classified early fragmentation stage films by both Herring and Catterall classifications. The interobserver reliability of the Herring classification was significantly better than the reliability of the Catterall measure.

Hip Joint↗
PubMed1994

Agreement among and within groups of pathologists in the classification of rhabdomyosarcoma and related childhood sarcomas. Report of an international study of four pathology classifications.

BACKGROUND: An International Pathology study was conducted to measure the agreement demonstrated among and within groups of pathologists involved in the categorization of childhood rhabdomyosarcoma according to four pathology classifications. Data concerning agreement and survival experience according to patho-new subtypes were used as a basis for selection of a proposed new pathologic classification. METHODS: A random sample of 800 eligible patients was chosen from the Intergroup Rhabdomyosarcoma Study II (IRS-II) and was reviewed by pathologists representing eight institutions. A 20% sample of the 800 patients was then reviewed by the pathologists to determine the level of agreement with their original classification. In each instance the patients were classified according to four pathology systems: the conventional system, the International Society for Pediatric Oncology system (SIOP), the National Cancer Institute (NCI) system, and the cytohistologic system. RESULTS: Among the groups of pathologists, the highest measure of agreement was a Kappa value of K = 0.451 for the conventional system, followed by K = 0.406 for the SIOP system, K = 0.384 for the NCI system, and K = 0.328 for the cytohistologic system. For reproducibility within the groups of pathologists, the highest measure of agreement was K = 0.605 for the conventional system, followed by K = 0.579 for the NCI system, K = 0.573 for the SIOP system, and K = 0.508 for the cytohistologic system. CONCLUSIONS: There was a general similarity between the agreement reached within the modified conventional, STOP, and NCI systems, with the modified conventional system having the highest Kappa values, and thus the highest measure of agreement, both among and within the groups of pathologists. Also, the subtypes of the conventional system demonstrated a highly significant relationship to survival time. Hence, based on criteria of reproducibilty and prognostic significance, the proposed classification will essentially be a modification of the conventional system with elements of the SIOP and NCI systems.

Adolescent↗
PubMed1982

A group study for the classification of anorectal anomalies in Japan with comments to the International Classification (1970).

A study group was formed to undertake further investigation of the problems involved in the classification of anorectal anomalies. At first, a registration form including standardized techniques for clinical and roentogenologic investigation was defined, and then 254 cases were collected and analyzed by referring these materials to the International Classification by the Melbourne group in 1970. Our analysis disclosed: (1) It is imperative to establish a registration form with footnotes describing standardized techniques for clinical and roentogenologic investigations; (2) The rectourethral fistula has been classified simply as high type under the present International Classification, but differences in the levels of the rectal pouch and of the point of fistula, as observed in the collected materials, tends to show that further subdivision of this anomaly may be indicated; (3) An abnormal skin fold at the anal and/or perineal sites is not always diagnostic of low type, specifically of covered anus-complete. Conversely, some infants with high type anomaly had abnormal skin folds; and (4) Two types of anomaly, which have not been well described in the present classification, were detected. They were "rectal membraneous atresia" and "recto-penile fistula."

Anal Canal↗
PubMed2002

Fundamental classification of perinatal death. Validation of a new classification system of perinatal death.

OBJECTIVE: To validate a newly introduced classification system for the registration of perinatal mortality. DESIGN: Descriptive. SETTING: Dutch Healthcare region Delft-Westland-Oostland (DWO). MATERIAL AND METHODS: In a 10-years period (1983-1992), all cases of perinatal death with a birthweight above 500 g (n=239) were included into the study. Six assessors: four gynaecologists and two paediatricians were asked to classify all cases using a classification model proposed by the authors. This model is based on the underlying cause of death using simple principles of obstetrical and neonatal pathology: birth trauma, infection, placenta or cord pathology, pathology of immune tolerance of mother and fetus, congenital malformation of the fetus and complications of a pre-viable delivery. Therefore, we used the term fundamental classification. The six assessors worked independently of each other in classifying all cases of perinatal death, were not involved in the original development of the system and were unaware of the results of the classification of their colleagues. Agreement beyond chance between assessors was calculated using kappa's coefficient for multiple observers and multiple test results. RESULTS: Overall kappa was 0.70 (95% confidence interval (C.I.) 0.68-0.72). Reproducibility was poor for the categories trauma and unclassifiable, fair for the categories infections and placental/cord pathology, and very good to excellent for the categories maternal immune system pathology, congenital malformations and complications of prematurity. CONCLUSIONS: The proposed system showed a good level of agreement and appeared to be simply applicable. It offers a good insight in the underlying cause of death with the possibility for recognising preventive factors in future pregnancies and will enable (inter)national comparisons in causes of perinatal death. A reliable uniform registration of perinatal death based on the underlying causes should be the basis for improvement of the quality of perinatal care.

Birth Injuries↗
PubMed1997

[Histological classification of renal cell carcinoma--problems in JUA classification].

BACKGROUND: Although renal cell carcinoma (RCC) is often heterogeneous, the histological classification of RCC in Japanese Urological Association (JUA) is designed to select only the dominant histological components. We evaluated whether this system could provide an adequate information concerning the prognosis of the patients. METHODS: Histological slides of 130 cases with RCC were microscopically evaluated. We classified these cases according to the JUA classification, and also checked the presence or absence of each histological components (3 cell types and 5 histological architectures) regardless of whether or not they were dominant. Univariate and multivariate analysis were then performed to determine the histological components which have prognostic impact on patient survival. RESULTS: Multivariate analysis demonstrated that only spinde/pleomorphic cells and solid architecture were the significant prognostic parameters. The presence of these histological components was not correctly shown in the JUA classification. CONCLUSION: The histological classification of RCC in JUA did not provide enough information about the presence of the important prognostic parameters. This system should be modified to describe all the histological components regardless of whether they are dominant or not.

Adult↗
PubMed2001

[Clinical significance of WHO classification and MDS 2000 classification in myelodysplastic syndromes].

Excluding chronic myelomonocytic leukemia, a total of 92 consecutive patients with myelodysplastic syndrome showing less than 20% blasts in the bone marrow were analyzed. We evaluated the clinical significance of the WHO and MDS 2000 classifications by reviewing each MDS patient according to the classification. The WHO criteria classified the MDS patients into 36 with RA, 22 with RCMD and 33 with RAEB, whereas according to the MDS 2000 criteria there were 19 RAEB-I patients and 15 RAEB-II patients. Based on the WHO classification, the RCMD patients had higher platelet counts and percentages of blasts among BM cells than the RA patients (P = 0.0018, P = 0.0001). Twenty percent of the RA patients, 44.8% of the RCMD patients, and 70.8% of the RAEB patients had cytogenetic abnormalities. Among them, the poor karyotype was present in 6.7% of the RA patients, 21.0% of the RCMD patients and 41.6% of the RAEB patients. The rate of acute leukemia death was 14.3% in the RA patients, 67.7% in the RAEB patients and 50.0% in the RCMD patients. Analysis of survival times revealed significant differences between RA and RCMD patients (P = 0.0482). The clinical features of RCMD patients were intermediate between those of RAEB and RA patients. There was no difference between the clinical features of the RAEB-I and RAEB-II patients in the MDS 2000 classification.

Aged↗
PubMed1992

Classification of accidents in the Arctic. A suggestion for adaptation of the Nordic classification for accident monitoring.

Since 1980 the Nordic Medico-Statistical Committee (NOMESCO) has supported the development of the Classification for Accident Monitoring. The objective of the Classification is to provide the foundation for accident prevention. In agreement with the purpose of NOMESCO to establish comparable medical statistics in the Nordic countries, it is considered how the Nordic Classification might be adapted to conditions in Arctic areas, in order also to facilitate accident prevention in these areas. The Classification is multiaxial and describes place of occurrence, injury mechanism, activity (of victim), products involved in accidents, and information of special relevance to traffic accidents and occupational accidents. The hierarchical build-up of the coding system allows subspecification of the variables mentioned above, thus enabling the system to contain such information which is suggested for Arctic areas, and at the same time preserving the comparability of data at an aggregated level. Further development is suggested in a plan of work.

Accidents↗
PubMed2004

Categorizing patients with occupational low back pain by use of the Quebec Task Force Classification system versus pain pattern classification procedures: discriminant and predictive validity.

BACKGROUND AND PURPOSE: Quebec Task Force Classification (QTFC) and pain pattern classification (PPC) procedures, including centralization and noncentralization, are common classification procedures. Classification was done to estimate validity of data obtained with QTFC and PPC procedures for differentiating patient subgroups at intake and for use in predicting rehabilitation outcomes at discharge and work status at 1 year after discharge from rehabilitation. SUBJECTS: Patients (n=171, 54% male; mean age=37 years, SD=10, range=18-62) with acute work-related low back pain referred for physical therapy were analyzed. METHODS: Patients completed pain and psychosocial questionnaires at initial examination and discharge and pain diagrams throughout intervention. Physical therapists classified patients using QTFC and PPC data at intake. Patients were classified again at discharge by PPC (time-dependent PPC). RESULTS: Analysis of variance of showed QTFC and PPC data could be used to differentiate patients by pain intensity or disability at intake. Analysis of covariance showed that intake PPC predicted pain intensity and disability at discharge, but QTFC did not. Logistic regression showed that PPC predicted work status at 1 year, but QTFC did not. Classifying patients over time using time-dependent PPC data reduced the false positive rate by 31% and increased percentage of change in pretest-posttest probability of return to work by 16% compared with classifying patients at intake. DISCUSSION AND CONCLUSION: Results support the discriminant validity of the QTFC data at intake and predictive validity of the PPC data at intake. Tracking PPC over time increases predictive validity for 1-year work status.

Acute Disease↗
PubMed1991

Classification of lung cancer: first experiences with the new TNM classification (4th edition).

In January 1987, the 4th edition of the TNM classification for malignant lung tumours by the International Union Cancer (UICC) came into effect. Thus, for the first time, a uniform worldwide staging system for lung cancer became available. In order to validate the new TNM definitions for lung cancer the data of 3,000 patients were analysed prospectively. Several items were examined: 1) the agreement between clinically (TNM) and pathologically (pTNM) confirmed classification; 2) the value of the various diagnostic techniques estimating the pathologically confirmed classification; 3) the influence of the TNM definitions on separating distinct prognostic groups. With regard to the primary tumour (T), clinical and pathological classifications were identical in 64%; for lymph node involvement (N) the agreement was 48%; for distant metastases it was 90% and for the stages it was 55%. As for the primary tumour (T) the accuracy of radiography (59%) was nearly identical to computed tomography (58%). Both techniques were less precise in determining the extent of lymph node involvement (computed tomography 50%, radiography 43%, correct assessments). The statistically significant differences in prognosis for the various T-, N- and M-categories as well as for the stages could be confirmed. By the new 1987 TNM definitions (4th edition) for lung cancer international conformity became feasible as well as practical, and the improvement in its prognostic relevance provided, therefore, a more reliable basis for establishing guidelines for individual oncological concepts of therapy.

Carcinoma, Bronchogenic↗
PubMed1983

[Malignant ventricular hyperkinetic arrhythmias. Classificational criteria: review of Lown's classification. Polycentric study].

Although Lown grading system of ventricular premature complexes (VPCs) has important conceptual shortcomings and has shown severe limitations in either cross-sectional or longitudinal studies, this classification is still the most well-known and used method to characterize the arrhythmologic ventricular pattern of the individual patient. We have looked at a modification of VPCs Lown grading scheme to correct the defects and to make the use of the classification more accurate. Our proposal is based on maintenance of 5 classes--similar to those of Lown original classification--to which we have assigned a score from 0 to 60. We have also introduced many sub-classes, each with a definite score, to better characterize the type of arrhythmic event. The sum of the score of the highest class and the score of every subclass furnishes the final score. This score is a direct index of the importance of the ventricular arrhythmias and seems to be useful for statistical evaluation of the anti-arrhythmic therapy and for follow-up studies, as confirmed by preliminary clinical results obtained through the use of this new VPCs classification.

Arrhythmias, Cardiac↗
PubMed1982

The classification of anxiety and hysterical states. Part II. Toward a more heuristic classification.

In the historical review and empirical delineation of the classification of anxiety and hysterical states (Part I), it was concluded that the existing classifications are unsatisfactory and require some reconceptualization if they are to be useful clinically and empirically. In keeping with more recent developments in the genetic, behavioral, pharmacological, biochemical, and psychophysiological investigation of these disorders, a new classification is proposed. The two major categories of anxiety and hysterical disorders have a different clinical presentation and course, a different mean age of onset, distribution of age of onset, sex distribution, response to treatment modalities, and habituation response on galvanic skin response. Empirical evidence supporting this proposal is cited. This classification has heuristic merit in guiding research efforts and discussions and in directing clinicians to a simple and practical solution to their patients' anxiety disorders.

Adult↗
PubMed1994

[The new international psychiatric classification system, ICD-10. II. New classification systems in psychiatry].

The different interpretations of the concept of "mental disease" and the absence of an etiopathogenetic plane in the area of mental disorders led to the creation of descriptive (phenomenological) classifications of mental disorders. Their main representatives are the American diagnostic and statistical manual of mental disorders, DSM-III, its revised version DSM-III-R and the new international classification of mental disorders iCD-10. Both systems use a common theoretical baseline and are to a considerable extent compatible. Typically they have a high reliability and low validity of diagnostic categories. Subsequent development of psychiatric classifications will be focused in particular on improvement of diagnostic validity. The international psychiatric classification was created in different versions for the purpose of specialized psychiatric care, primary care and for research.

Humans↗