Records that met at least one of the above diagnostic criteria were termed ‘diagnosable NMS’. Demographic data (age, sex and year of the suspected NMS) were also collected for each

record. The Pope recommendations also allow an alternative category of ‘probable NMS’ which is designed for retrospective definition when documentation is inadequate; this was treated as a separate outcome [Pope et al. 1986]. Statistical analysis Chance-corrected proportional agreements between sets of criteria were calculated using pairwise Inhibitors,research,lifescience,medical κ indices and among all sets combined. In addition, comparisons of presence, absence, or ‘no mention’ for specific symptoms/signs between the group who fulfilled any diagnosis (n = 43) and the group who did not (n = 140) were performed using χ2 tests. All statistical analyses were carried out using Stata Special Edition V.10.0 software. Results Of 485 cases returned by the initial text search, 302 were excluded as clearly irrelevant or failing to meet inclusion criteria, leaving 183 cases Inhibitors,research,lifescience,medical for which NMS had been considered clinically resulting in further investigation or other action. Of these, 43 could be judged from the available information to meet at least one set of the six diagnostic criteria (Table 1) which, together with the

overlapping 46 ‘probable’ cases according to the criteria of Pope Inhibitors,research,lifescience,medical and colleagues [Pope et al. 1986] gave a wider group of 73 potential cases. No case GSK2656157 record returned Inhibitors,research,lifescience,medical more than one episode of suspected or diagnosable NMS. The mean age of all 183 suspected

cases was 43.2 years (SD = 18.0) and 121 (66.1%) were men. The mean age of the 43 identified cases was 45.7 years (SD = 18.0) and 30 (79.7%) were men. The first suspected NMS Inhibitors,research,lifescience,medical case was identified in 2001 but the subject did not meet any of the six criteria. The majority of cases were identified from 2006 to 2008 (details not shown). Table 1. Characteristics of suspected neuroleptic malignant syndrome cases meeting specific diagnostic criteria. No case met the research diagnostic criteria of Adityanjee and colleagues [Adityanjee et al. 1999], but 11 cases met the clinical criteria of NMS suggested by Adityanjee and colleagues [Adityanjee et al. 1988]. Only one case met all six sets Megestrol Acetate of the remaining criteria (Table 2). For the six core sets of criteria, the combined level of agreement (κ) was 0.35 [95% confidence interval (CI) 0.31–0.39]. For the seven wider sets of criteria (i.e. when the ‘probable’ cases identified by the retrospective criteria of Pope and colleagues were also included) the combined κ dropped to 0.27 (0.23–0.31). Pairwise agreements are represented in Table 3, which showed wide variation, with the highest κ statistics for Levenson with Addonizio and colleagues (the most inclusive sets), and for Pope and colleagues with DSM-IV. Table 2.