Bushnell C D, Johnston D C, Goldstein L B
Department of Medicine (Neurology), Duke Center for Cerebrovascular Disease, Duke University and Durham Veteran's Affairs Medical Center, Durham, NC 27710, USA.
Stroke. 2001 Mar;32(3):656-60. doi: 10.1161/01.str.32.3.656.
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.
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.
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).
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.
据报道，美国国立卫生研究院卒中量表（NIHSS）和加拿大神经量表（CNS）可用于回顾性评估初始卒中严重程度。然而，与CNS不同，NIHSS需要详细的神经学评估，而这可能并非在所有患者记录中都有体现，这可能会限制其适用性。我们评估了一所学术医疗中心（AMC）和两家社区医院收治的卒中患者中，NIHSS和CNS回顾性算法的可靠性以及缺失项目的比例。
回顾随机选取的入住AMC（n = 20）以及有（CH1，n = 19）和没有（CH2，n = 20）急性神经科会诊服务的社区医院的缺血性卒中患者的记录。两名神经科医生使用已发表的算法独立分配NIHSS和CNS评分。使用组内相关系数确定评分的评分者间信度，并列出缺失项目的数量。
AMC中NIHSS和CNS的组内相关系数分别为0.93（95%CI，0.82至1.00）和0.97（95%CI，0.90至1.00），CH1中分别为0.89（95%CI，0.75至1.00）和0.88（95%，0.73至1.00），CH2中分别为0.48（95%CI，0.26至0.70）和0.78（95%CI，0.60至0.96）。CH2中NIHSS缺失的项目（62%）多于AMC（27%）和CH1（23%，P = 0.0001）。相比之下，CH2、AMC和CH1记录中CNS项目的缺失率分别为33%、0%和8%（P = 0.0001）。
对于最初由神经科医生在AMC和CH进行评估的患者，回顾性分配的NIHSS和CNS评分的评分者间一致性水平几乎完美。在CH2中CNS的一致性水平较高，但在这种情况下NIHSS的评分者间一致性仅为中等。在每种情况下，NIHSS缺失项目的比例均高于CNS，这尤其限制了其在没有急性神经科会诊服务的医院中的应用。
