Sackler Faculty of Medicine, The Herczeg Institute on Aging and The Stanley Steyer School of Health Professions, Tel Aviv University, 6997801, Tel Aviv, Israel.
Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA.
Sci Rep. 2022 Jul 19;12(1):12338. doi: 10.1038/s41598-022-16522-7.
Stroke severity is the most important predictor of post-stroke outcome. Most longitudinal cohort studies do not include direct and validated measures of stroke severity, yet these indicators may provide valuable information about post-stroke outcomes, as well as risk factor associations. In the Atherosclerosis Risk in Communities (ARIC) study, stroke severity data were retrospectively collected, and this paper outlines the procedures used and shares them as a model for assessment of stroke severity in other large epidemiologic studies. Trained physician abstractors, who were blinded to other clinical events, reviewed hospital charts of all definite/probable stroke events occurring in ARIC. In this analysis we included 1,198 ischemic stroke events occurring from ARIC baseline (1987-1989) through December 31, 2009. Stroke severity was categorized according to the National Institutes of Health Stroke Scale (NIHSS) score and classified into 5 levels: NIHSS ≤ 5 (minor), NIHSS 6-10 (mild), NIHSS 11-15 (moderate), NIHSS 16-20 (severe), and NIHSS > 20 (very severe). We assessed interrater reliability in a subgroup of 180 stroke events, reviewed independently by the lead abstraction physician and one of the four secondary physician abstractors. Interrater correlation coefficients for continuous NIHSS score as well as percentage of absolute agreement and Cohen Kappa Statistic for NIHSS categories were presented. Determination of stroke severity by the NIHSS, based on data abstracted from hospital charts, was possible for 97% of all ischemic stroke events. Median (25%-75%) NIHSS score was 5 (2-8). The distribution of NIHSS category was NIHSS ≤ 5 = 58.3%, NIHSS 6-10 = 24.5%, NIHSS 11-15 = 8.9%, NIHSS 16-20 = 4.7%, NIHSS > 20 = 3.6%. Overall agreement in the classification of severity by NIHSS category was present in 145/180 events (80.56%). Cohen's simple Kappa statistic (95% CI) was 0.64 (0.55-0.74) and weighted Kappa was 0.79 (0.72-0.86). Mean (SD) NIHSS score was 5.84 (5.88), with a median score of 4 and range 0-31 for the lead reviewer (rater 1) and mean (SD) 6.16 (6.10), median 4.5 and range 0-36 in the second independent assessment (rater 2). There was a very high correlation between the scores reported in both assessments (Pearson r = 0.90). Based on our findings, we conclude that hospital chart-based retrospective assessment of stroke severity using the NIHSS is feasible and reliable.
卒中严重程度是卒中后结局最重要的预测指标。大多数纵向队列研究并未包含直接和经过验证的卒中严重程度指标，但这些指标可能提供有关卒中后结局以及危险因素相关性的有价值信息。在动脉粥样硬化风险社区（ARIC）研究中，卒中严重程度数据是回顾性收集的，本文概述了所采用的程序，并将其作为在其他大型流行病学研究中评估卒中严重程度的模型进行分享。经过培训的医师记录员对其他临床事件进行了盲法评估，对 ARIC 中发生的所有明确/可能的卒中事件的医院病历进行了回顾。在本分析中，我们纳入了 1198 例从 ARIC 基线（1987-1989 年）到 2009 年 12 月 31 日期间发生的缺血性卒中事件。卒中严重程度根据国立卫生研究院卒中量表（NIHSS）评分进行分类，并分为 5 个级别：NIHSS≤5（轻度），NIHSS 6-10（轻度），NIHSS 11-15（中度），NIHSS 16-20（重度）和 NIHSS＞20（非常严重）。我们在 180 例卒中事件的亚组中评估了观察者间可靠性，由主要记录员和 4 名次要记录员中的一名独立评估。呈现了连续 NIHSS 评分的观察者间相关系数以及 NIHSS 分类的绝对一致百分比和 Cohen Kappa 统计量。基于从医院病历中提取的数据，使用 NIHSS 确定卒中严重程度的可能性为所有缺血性卒中事件的 97％。中位数（25％-75％）NIHSS 评分为 5（2-8）。NIHSS 类别分布为 NIHSS≤5=58.3％，NIHSS 6-10=24.5％，NIHSS 11-15=8.9％，NIHSS 16-20=4.7％，NIHSS＞20=3.6％。180 例事件中有 145 例（80.56％）在 NIHSS 类别严重程度分类中存在总体一致。Cohen 的简单 Kappa 统计量（95％CI）为 0.64（0.55-0.74），加权 Kappa 为 0.79（0.72-0.86）。主要记录员（评分者 1）的平均（SD）NIHSS 评分为 5.84（5.88），中位数为 4，范围为 0-31，第二位独立评估者（评分者 2）的平均（SD）NIHSS 评分为 6.16（6.10），中位数为 4.5，范围为 0-36。两项评估报告的评分之间存在高度相关性（Pearson r=0.90）。基于我们的发现，我们得出结论，使用 NIHSS 基于医院病历回顾性评估卒中严重程度是可行且可靠的。
