C D Bushnell1, D C Johnston, L B Goldstein. 1. Department of Medicine (Neurology), Duke Center for Cerebrovascular Disease, Duke University and Durham Veteran's Affairs Medical Center, Durham, NC 27710, USA.
Abstract
BACKGROUND AND PURPOSE: The NIH Stroke Scale (NIHSS) and the Canadian Neurological Scale (CNS) have been reported to be useful for the retrospective assessment of initial stroke severity. However, unlike the CNS, the NIHSS requires detailed neurological assessments that may not be reflected in all patient records, potentially limiting its applicability. We assessed the reliability of the retrospective algorithms and the proportions of missing items for the NIHSS and CNS in stroke patients admitted to an academic medical center (AMC) and 2 community hospitals. METHODS: Randomly selected records of patients with ischemic stroke admitted to an AMC (n=20) and community hospitals with (CH1, n=19) and without (CH2, n=20) acute neurological consultative services were reviewed. NIHSS and CNS scores were assigned independently by 2 neurologists using published algorithms. Interrater reliability of the scores was determined with the intraclass correlation coefficient, and the numbers of missing items were tabulated. RESULTS: The intraclass correlation coefficient for NIHSS and CNS, respectively, were 0.93 (95% CI, 0.82 to 1.00) and 0.97 (95% CI, 0.90 to 1.00) for the AMC, 0.89 (95% CI, 0.75 to 1.00) and 0.88 (95%, 0.73 to 1.00) for the CH1, and 0.48 (95% CI, 0.26 to 0.70) and 0.78 (95% CI, 0.60 to 0.96) for the CH2. More NIHSS items were missing at the CH2 (62%) versus the AMC (27%) and the CH1 (23%, P:=0.0001). In comparison, 33%, 0%, and 8% of CNS items were missing from records from CH2, AMC, and CH1, respectively (P:=0.0001). CONCLUSIONS: The levels of interrater agreement were almost perfect for retrospectively assigned NIHSS and CNS scores for patients initially evaluated by a neurologist at both an AMC and a CH. Levels of agreement for the CNS were substantial at a CH2, but interrater agreement for the NIHSS was only moderate in this setting. The proportions of missing items are higher for the NIHSS than the CNS in each setting, particularly limiting its application in the hospital without acute neurological consultative services.
BACKGROUND AND PURPOSE: The NIH Stroke Scale (NIHSS) and the Canadian Neurological Scale (CNS) have been reported to be useful for the retrospective assessment of initial stroke severity. However, unlike the CNS, the NIHSS requires detailed neurological assessments that may not be reflected in all patient records, potentially limiting its applicability. We assessed the reliability of the retrospective algorithms and the proportions of missing items for the NIHSS and CNS in strokepatients admitted to an academic medical center (AMC) and 2 community hospitals. METHODS: Randomly selected records of patients with ischemic stroke admitted to an AMC (n=20) and community hospitals with (CH1, n=19) and without (CH2, n=20) acute neurological consultative services were reviewed. NIHSS and CNS scores were assigned independently by 2 neurologists using published algorithms. Interrater reliability of the scores was determined with the intraclass correlation coefficient, and the numbers of missing items were tabulated. RESULTS: The intraclass correlation coefficient for NIHSS and CNS, respectively, were 0.93 (95% CI, 0.82 to 1.00) and 0.97 (95% CI, 0.90 to 1.00) for the AMC, 0.89 (95% CI, 0.75 to 1.00) and 0.88 (95%, 0.73 to 1.00) for the CH1, and 0.48 (95% CI, 0.26 to 0.70) and 0.78 (95% CI, 0.60 to 0.96) for the CH2. More NIHSS items were missing at the CH2 (62%) versus the AMC (27%) and the CH1 (23%, P:=0.0001). In comparison, 33%, 0%, and 8% of CNS items were missing from records from CH2, AMC, and CH1, respectively (P:=0.0001). CONCLUSIONS: The levels of interrater agreement were almost perfect for retrospectively assigned NIHSS and CNS scores for patients initially evaluated by a neurologist at both an AMC and a CH. Levels of agreement for the CNS were substantial at a CH2, but interrater agreement for the NIHSS was only moderate in this setting. The proportions of missing items are higher for the NIHSS than the CNS in each setting, particularly limiting its application in the hospital without acute neurological consultative services.
Authors: Lauren A Beslow; Scott E Kasner; Sabrina E Smith; Michael T Mullen; Matthew P Kirschen; Rachel A Bastian; Michael M Dowling; Warren Lo; Lori C Jordan; Timothy J Bernard; Neil Friedman; Gabrielle DeVeber; Adam Kirton; Lisa Abraham; Daniel J Licht; Abbas F Jawad; Jonas H Ellenberg; Ebbing Lautenbach; Rebecca N Ichord Journal: Stroke Date: 2011-11-10 Impact factor: 7.914
Authors: Gustavo Saposnik; Robert Teasell; Muhammad Mamdani; Judith Hall; William McIlroy; Donna Cheung; Kevin E Thorpe; Leonardo G Cohen; Mark Bayley Journal: Stroke Date: 2010-05-27 Impact factor: 7.914
Authors: Gustavo Saposnik; Moira K Kapral; Robert Cote; Paula A Rochon; Julie Wang; Stavroula Raptis; Muhammad Mamdani; Sandra E Black Journal: J Neurol Date: 2012-04-25 Impact factor: 4.849
Authors: Dorothee Saur; Thomas Kucinski; Ulrich Grzyska; Bernd Eckert; Christian Eggers; Wolf Niesen; Volker Schoder; Hermann Zeumer; Cornelius Weiller; Joachim Röther Journal: AJNR Am J Neuroradiol Date: 2003-05 Impact factor: 3.825