Development of a Novel, Weighted, Quantifiable Stroke Scale: Japan Stroke Scale
Development of a Novel, Weighted, Quantifiable Stroke Scale: Japan Stroke Scale
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开发一种新颖的、加权的、可量化的中风量表：日本中风量表
作者：
F. Gotoh;Y. Terayama;T. Amano
背景和目的-有几种卒中量表可用于评估卒中的严重程度，但没有一种量表能提供关于观察变量相对权重的信息。为了定义中风的综合严重程度，我们开发了一个可量化的中风量表，其中包含加权变量，应用联合分析来计算每个项目的相对权重。方法-我们选择了10个变量（意识，语言，忽视，偏盲，凝视，瞳孔异常，面神经麻痹，足底反射，感觉和虚弱）的基础上的多变量分析的京王大学中风患者数据库电池。对变量进行分类，并评估其分布和敏感性。然后修改并重新检查分类。重复该程序，直到从198名患者中获得适当的分类。然后制定了一个临时的中风量表，没有重量，并检查和修订80例新的中风患者的量表的可靠性。下一步，150名神经科医生被要求对一组27名虚拟患者进行排名，每个患者都有不同的变量组合，根据严重程度。从这些排名中，联合分析被用来获得每个因素水平的效用得分（权重）。结果-各因素的相对权重如下：意识49.8%，语言9.9%，下肢无力7.3%，瞳孔异常6.8%，凝视麻痹5.6%，臂无力4.3%，手无力3.7%，忽视3.7%，面神经麻痹2.4%，足底反射2.2%，偏盲2.2%，感觉障碍2.1%。患者的总评分可以根据每个变量的评分之和计算，范围为-0.38至27.86。对100例急性脑卒中患者进行评分，并跟踪评分变化进行验证。患者的纵向临床监测与每个患者的评分相关性良好。量表的评分者间和评分者内信度均非常好（加权0.83; Cronbach's 0.998）。结论：日本卒中量表是一种参数卒中量表，可定量测量卒中的严重程度。根据中风的严重程度，量表的每个变量都有一个相对权重。可靠性和反应性被证明是极好的。目前的数据显示，从临床角度来看，日本卒中量表有可能成为一个普遍接受和可靠的标准化系统。
Background and Purpose— Several stroke scales are available for estimation of the severity of stroke, but none of them provides information regarding the relative weights of the observed variables. To define an integrated severity of stroke, we developed a quantifiable stroke scale with weighted variables that apply conjoint analysis to calculate the relative weight of each item. Methods— We selected 10 variables (consciousness, language, neglect, hemianopsia, gaze, pupillary abnormality, facial palsy, plantar reflex, sensation, and weakness) based on the multivariate analysis of the Keio Stroke Patient Database Battery. The variables were categorized and evaluated for their distribution and sensitivity. The categorizations were then modified and rechecked. The procedure was repeated until the appropriate categorization was obtained from 198 patients. A temporary stroke scale without weight was then formulated, and the reliability of the scale was examined and revised with 80 new stroke patients. As a next step, 150 neurologists were asked to rank a set of 27 virtual patients, each with a different combination of variables, according to severity. From these rankings, conjoint analysis was used to derive utility scores (weights) for each factor level. Results— The relative weights of each of the factors were as follows: consciousness 49.8%, language 9.9%, weakness of lower extremity 7.3%, pupillary abnormality 6.8%, gaze palsy 5.6%, weakness of arm 4.3%, weakness of hand 3.7%, neglect 3.7%, facial palsy 2.4%, plantar reflex 2.2%, hemianopsia 2.2%, and sensory impairment 2.1%. The total score for a patient could be calculated from the sum of the scores for each of the variables ranging from −0.38 to 27.86. Scoring of 100 patients with acute stroke was carried out, and the changes in scores were followed for validation. Longitudinal clinical monitoring of the patients correlated well with the scores in each patient. The interrater and intrarater reliabilities of the scale were excellent (weighted &kgr; 0.83; Cronbach’s &agr; 0.998). Conclusions— The Japan Stroke Scale is a parametric stroke scale that provides a quantitative measure of the severity of stroke. Each of the variables of the scale has a relative weight according to the severity of stroke. Reliability and responsiveness were proved to be excellent. The present data revealed a potentiality for the Japan Stroke Scale to be a universally accepted and reliable standardized system from the clinimetrical point of view.
影响因子：
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作者：
GOLDSTEIN, LB;BERTELS, C;DAVIS, JN
通讯作者：
DAVIS, JN