Retrospective assessment of initial stroke severity - Comparison of the NIH Stroke Scale and the Canadian Neurological Scale
Retrospective assessment of initial stroke severity - Comparison of the NIH Stroke Scale and the Canadian Neurological Scale
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DOI：
10.1161/01.str.32.3.656
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发表时间：
2001-03-01
期刊：
影响因子：
8.3
通讯作者：
Goldstein, LB
中科院分区：
文献类型：
--
作者：
Bushnell, CD;Johnston, DCC;Goldstein, LB
背景和目的：据报道，美国国立卫生研究院卒中评定量表(NIHSS)和加拿大神经病学评定量表(CNS)可用于对初始卒中严重程度的回顾性评估。然而，与CNS不同的是，NIHSS需要详细的神经评估，而这些评估可能并不反映在所有患者的记录中，这可能限制了其适用性。我们评估了在一个学术医学中心(AMC)和2个社区医院住院的中风患者的NIHSS和CNS缺失条目的比例和回顾算法的可靠性。方法：随机选择在AMC(n=20)和社区医院(CH1，n=19)和没有(CH2，n=20)急性神经咨询服务的缺血性中风患者的记录。NIHSS和CNS评分由两名神经科医生使用已发表的算法独立分配。结果NIHSS和CNS的组内相关系数AMC分别为0.93(95%CI，0.82~1.00)和0.97(95%CI，0.90~1.00)，CH1为0.89(95%CI，0.75~1.00)和0.88(95%CI，0.73~1.00)，CNS为0.48(95%CI，0.75~1.00)，CH2为0.26~0.70)和0.78(95%CI，0.60~0.96)。CH2(62%)比AMC(27%)和CH1(23%，P=0.0001)有更多的NIHSS项目缺失。相比之下，CH2、AMC和CH1的记录中分别遗漏了33%、0%和8%的CNS项目(P=0.0001)。结论-对于由AMC和CH1的神经科医生最初评估的患者，评价者间的一致性水平几乎完全符合NIHSS和CNS评分。在CH2，对CNS的协议水平很高，但在这种情况下，NIHSS的评价者之间的协议只是中等水平。在各种情况下，NIHSS的缺项比例均高于CNS，特别是限制了其在没有急性神经咨询服务的医院的应用。
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.