Reeves Mathew J, Smith Eric E, Fonarow Gregg C, Zhao Xin, Thompson Michael, Peterson Eric D, Schwamm Lee H, Olson DaiWai
From the Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R., M.T.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada (E.E.S.); Division of Cardiology, Geffen School of Medicine, UCLA (G.C.F.); Duke Clinical Research Centre, Durham, NC (X.Z., E.D.P.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas (D.O.).
Circ Cardiovasc Qual Outcomes. 2015 Oct;8(6 Suppl 3):S90-8. doi: 10.1161/CIRCOUTCOMES.115.001775.
Although National Institutes of Health Stroke Scale (NIHSS) is an important prognostic variable, it is often incompletely documented in clinical registries, such as Get With The Guidelines (GWTG)-Stroke. We describe trends in NIHSS documentation by GWTG-Stroke hospitals, identify patient-level and hospital-level factors associated with documentation, and determine the degree to which the reporting of NIHSS is potentially biased.
We analyzed NIHSS documentation in 1 184 288 patients with acute ischemic stroke admitted to 1704 GWTG-Stroke hospitals between 2003 and 2012. We used multivariable logistic regression models to identify hospital-level and patient-level predictors of NIHSS documentation. We examined the relationship between hospital-level NIHSS documentation rates and observed NIHSS scores to determine whether the reporting of NIHSS data was subject to selection bias. The overall NIHSS documentation rate was 56.1%; the median NIHSS was 4 (interquartile range, 2-9). Between 2003 and 2012, mean hospital-level NIHSS documentation increased dramatically from 27% to 70% (P<0.0001). Documentation was higher in patients who arrived by ambulance, who arrived soon after onset, and were treated at larger, primary stroke centers. Hospital-level NIHSS documentation rates and NIHSS scores were modestly inversely correlated (r=-0.207; P<0.0001), suggesting that NIHSS data from hospitals with low documentation were shifted toward higher values. In sensitivity analysis, the degree of bias in NIHSS reporting was reduced in more recent years (2011-2012) when NIHSS documentation was noticeably better.
Documentation of NIHSS is higher in patients who are thrombolysis candidates. Evidence of modest bias in NIHSS scores was observed but this has lessened as the documentation of NIHSS has improved in recent years.
尽管美国国立卫生研究院卒中量表（NIHSS）是一个重要的预后变量，但在临床登记中，如“遵循指南-卒中”（GWTG-卒中）项目中，其记录往往不完整。我们描述了GWTG-卒中项目医院中NIHSS记录的趋势，确定与记录相关的患者层面和医院层面因素，并确定NIHSS报告可能存在偏倚的程度。
我们分析了2003年至2012年间1704家GWTG-卒中项目医院收治的1184288例急性缺血性卒中患者的NIHSS记录情况。我们使用多变量逻辑回归模型来确定NIHSS记录的医院层面和患者层面预测因素。我们检查了医院层面NIHSS记录率与观察到的NIHSS评分之间的关系，以确定NIHSS数据报告是否存在选择偏倚。NIHSS的总体记录率为56.1%；NIHSS中位数为4（四分位间距，2 - 9）。2003年至2012年间，医院层面NIHSS的平均记录率从27%急剧上升至70%（P<0.0001）。通过救护车送达的患者、发病后不久即送达的患者以及在较大的初级卒中中心接受治疗的患者，其记录率更高。医院层面NIHSS记录率与NIHSS评分呈适度负相关（r = -0.207；P<0.0001），这表明记录率低的医院的NIHSS数据倾向于更高的值。在敏感性分析中，近年来（201l - 2012年）NIHSS记录明显改善时，NIHSS报告中的偏倚程度有所降低。
溶栓候选患者的NIHSS记录率更高。观察到NIHSS评分存在适度偏倚的证据，但随着近年来NIHSS记录的改善，这种偏倚有所减轻。
