Comparison of the King's and MiToS staging systems for ALS

Ton, Fang, Al Khleifat, Ahmad, Stahl, Daniel R, Lazo Dal Torre, Claudia, Murphy, Caroline, Young, Carolyn, Shaw, Pamela J, Leigh, P. Nigel, Al-Chalabi, Ammar and UK-MND, LicALS (2017) Comparison of the King's and MiToS staging systems for ALS. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 18 (3-4). pp. 227-232. ISSN 2167-8421

[img] PDF
Download (1MB)

Abstract

Objective: To investigate and compare two ALS staging systems, King’s clinical staging and Milano-Torino (MiToS) functional staging, using data from the LiCALS phase III clinical trial (EudraCT 2008-006891-31).

Methods: Disease stage was derived retrospectively for each system from the ALS Functional Rating Scale-Revised subscores using standard methods. The two staging methods were then compared for timing of stages using box plots, correspondence using chi-square tests, agreement using a linearly weighted kappa coefficient and concordance using Spearman’s rank correlation.

Results: For both systems, progressively higher stages occurred at progressively later proportions of the disease course, but the distribution differed between the two methods. King’s stage 3 corresponded to MiToS stage 1 most frequently, with earlier King’s stages 1 and 2 largely corresponding to MiToS stage 0 or 1. The Spearman correlation was 0.54. There was fair agreement between the two systems with kappa coefficient of 0.21.

Conclusion: The distribution of timings shows that the two systems are complementary, with King’s staging showing greatest resolution in early to mid-disease corresponding to clinical or disease burden, and MiToS staging having higher resolution for late disease, corresponding to functional involvement. We therefore propose using both staging systems when describing ALS

Item Type: Article
Keywords: Clinical stage, MiToS stage, King’s stage, prognosis, clinical trials
Schools and Departments: Brighton and Sussex Medical School > Neuroscience
Subjects: R Medicine > RC Internal medicine > RC0321 Neurosciences. Biological psychiatry. Neuropsychiatry > RC0346 Neurology. Diseases of the nervous system Including speech disorders
Depositing User: Patricia Butler
Date Deposited: 09 Jan 2017 17:39
Last Modified: 18 Aug 2017 03:32
URI: http://sro.sussex.ac.uk/id/eprint/66096

View download statistics for this item

📧 Request an update