The Norwegian Air Ambulance Foundation, Oslo, Norway (K.L., H.S.J., M.R.H., K.T., K.G.B.).
Institute of Basic Medical Sciences, University of Oslo, Norway (K.L., H.S.J., K.G.B.).
Stroke. 2022 Jun;53(6):2050-2057. doi: 10.1161/STROKEAHA.121.036084. Epub 2022 Mar 16.
National Institutes of Health Stroke Scale (NIHSS) is the most validated clinical scale for stroke recognition, severity grading, and symptom monitoring in acute care and hospital settings. Numerous modified prehospital stroke scales exist, but these scales contain less clinical information and lack compatibility with in-hospital stroke scales. In this real-life study, we aimed to investigate if NIHSS conducted by paramedics in the field is a feasible and accurate prehospital diagnostic tool.
This prospective cohort study is part of Treat-NASPP (Treat-Norwegian Acute Stroke Prehospital Project) conducted at a single medical center in Østfold, Norway. Sixty-three paramedics were trained and certified in NIHSS, and the prehospital NIHSS scores were compared with the scores obtained by in-hospital stroke physicians. Interrater agreement was assessed using a Bland-Altman plot with 95% limits of agreement. In secondary analysis, Cohen κ was used for the clinical categories NIHSS score of 0 to 5 and ≥6. As a safety measure, prehospital time was compared between paramedics conducting NIHSS and conventional paramedics.
We included 274 patients. The mean difference in NIHSS scores between the paramedics and the stroke physicians was 0.92 with limits of agreement from -5.74 to 7.59. Interrater agreement for the 2 clinical categories was moderate with a κ of 0.58. The prehospital NIHSS scoring was performed mean (SD) 42 (14) minutes earlier than the in-hospital scoring. Prehospital time was not significantly increased in the NIHSS-trained paramedic group compared with conventional paramedics (median [interquartile range] on-scene-time 18 [13-25] minutes versus 16 [11-23] minutes, =0.064 and onset-to-hospital time 86 [65-128] minutes versus 84 [56-140] minutes, =0.535).
Paramedics can use NIHSS as an accurate and time efficient prehospital stroke severity quantification tool. Introducing NIHSS in the emergency medical services will enable prehospital evaluation of stroke progression and provide a common language for stroke assessment between paramedics and stroke physicians.
URL: https://www.
gov; Unique identifier: NCT03158259.
美国国立卫生研究院卒中量表（NIHSS）是目前最常用于识别、严重程度分级和急性护理及住院环境下症状监测的临床量表。有许多改良的院前卒中量表，但这些量表包含的临床信息较少，与院内卒中量表缺乏兼容性。在这项真实世界的研究中，我们旨在探讨在现场由护理人员进行的 NIHSS 是否是一种可行且准确的院前诊断工具。
这项前瞻性队列研究是在挪威东福尔郡的一个单一医疗中心进行的 Treat-NASPP（挪威急性卒中院前项目）的一部分。63 名护理人员接受了 NIHSS 培训和认证，院前 NIHSS 评分与院内卒中医生获得的评分进行了比较。采用 Bland-Altman 图评估组内一致性，并用 95%一致性界限表示。在二次分析中，采用 Cohen κ 评估 NIHSS 评分 0-5 分和≥6 分的临床类别。作为安全措施，比较了进行 NIHSS 的护理人员与常规护理人员的院前时间。
我们纳入了 274 名患者。护理人员和卒中医生之间 NIHSS 评分的平均差值为 0.92，一致性界限为-5.74 至 7.59。对于 2 个临床类别，组内一致性为中度，κ 值为 0.58。院前 NIHSS 评分的完成时间比院内评分早平均（SD）42（14）分钟。与常规护理人员相比，接受 NIHSS 培训的护理人员的院前时间并没有显著增加（中位数[四分位距]现场时间为 18[13-25]分钟对 16[11-23]分钟，=0.064；发病至入院时间为 86[65-128]分钟对 84[56-140]分钟，=0.535）。
护理人员可以使用 NIHSS 作为一种准确且高效的院前卒中严重程度量化工具。在紧急医疗服务中引入 NIHSS 将能够对卒中进展进行院前评估，并为护理人员和卒中医生之间的卒中评估提供共同语言。
网址：https://www.
gov；独特标识符：NCT03158259。
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