Quinn Terence J, Ray Gautamananda, Atula Sari, Walters Matthew R, Dawson Jesse, Lees Kennedy R
Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Stroke. 2008 Dec;39(12):3421-3. doi: 10.1161/STROKEAHA.108.519306. Epub 2008 Sep 4.
Modified Rankin score (mRS) is traditionally graded using a face-to-face or telephone interview. Certain stroke assessment scales can be derived from a review of a patient's case-record alone. We hypothesized that mRS could be successfully derived from the narrative within patient case-records.
Sequential patients attending our cerebrovascular outpatient clinic were included. Two independent, blinded clinicians, trained in mRS, assessed case-records to derive mRS. They scored "certainty" of their grading on a 5-point Likert scale. Agreement between derived and traditional face-to-face mRS was calculated using attribute agreement analysis.
Fifty patients with a range of disabilities were included. Case-record appraisers were poor at deriving mRS (k=0.34 against standard). Derived mRS grades showed poor agreement between observers (k=0.33). There was no relationship between certainty of derived mRS and proportion of correct grades (P=0.727).
Accurate mRS cannot be derived from standard hospital records. Direct mRS interview is still required for clinical trials.
改良Rankin量表（mRS）传统上是通过面对面或电话访谈进行评分的。某些卒中评估量表仅通过查阅患者病历即可得出。我们推测mRS可以从患者病历中的叙述成功推导出来。
纳入在我们脑血管门诊就诊的连续患者。两名经过mRS培训的独立、不知情的临床医生评估病历以推导mRS。他们用5点李克特量表对评分的“确定性”进行打分。使用属性一致性分析计算推导得出的mRS与传统面对面mRS之间的一致性。
纳入了50名有不同程度残疾的患者。病历评估者在推导mRS方面表现不佳（与标准相比，k = 0.34）。推导得出的mRS等级在观察者之间的一致性较差（k = 0.33）。推导得出的mRS的确定性与正确等级的比例之间没有关系（P = 0.727）。
无法从标准医院记录中准确推导mRS。临床试验仍需要直接进行mRS访谈。
