Comer Amber R, Templeton Evan, Glidden Michelle, Bartlett Stephanie, D'Cruz Lynn, Nemati Donya, Zabel Samantha, Slaven James E
Indiana University School of Health and Human Sciences, Indianapolis, IN, United States.
Indiana University School of Medicine, Indianapolis, IN, United States.
Front Neurol. 2023 Jan 11;13:1093392. doi: 10.3389/fneur.2022.1093392. eCollection 2022.
Little is known about the consistency of initial NIHSS scores between neurologists and RNs in clinical practice.
A cohort study of patients with a code stroke was conducted at an urban academic Primary Stroke Center in the Midwest between January 1, 2018, and December 31, 2019 to determine consistency in National Institutes of Health Stroke Scale Scores (NIHSS) between neurologists and registered nurses (RNs).
Among the 438 patients included in this study 65.3% ( = 286) of neurologist-RN NIHSS scoring pairs had congruent scores. One-in-three, (34.7%, = 152) of neurologist-RN NIHSS scoring pairs had a clinically meaningful scoring difference of two points or greater. Higher NIHSS ( ≤ 0.01) and aphasia ( ≤ 0.01) were each associated with incongruent scoring between neurologist and emergency room RN pairs.
One-in-three initial NIHSS assessed by both a neurologist and RN had a clinically meaningful score difference between providers. More severe stroke, as indicated by a higher NIHSS was associated with scoring inconsistency between neurologist-RN pairs. Subjective scoring measures, especially those involving a patient having aphasia, was associated with greater score incongruency. Score differences may be attributed to differences in NIHSS training requirements between neurologists and RNs.
在临床实践中，关于神经科医生和注册护士（RN）之间初始美国国立卫生研究院卒中量表（NIHSS）评分的一致性，人们了解甚少。
2018年1月1日至2019年12月31日期间，在中西部一个城市学术性初级卒中中心对卒中编码患者进行了一项队列研究，以确定神经科医生和注册护士之间美国国立卫生研究院卒中量表（NIHSS）评分的一致性。
在本研究纳入的438例患者中，65.3%（n = 286）的神经科医生 - RN的NIHSS评分对具有一致的分数。三分之一（34.7%，n = 152）的神经科医生 - RN的NIHSS评分对在临床上具有两分或更大的有意义评分差异。较高的NIHSS评分（P≤0.01）和失语（P≤0.01）均与神经科医生和急诊室RN对之间的评分不一致相关。
由神经科医生和RN评估的初始NIHSS评分中，三分之一在医疗服务提供者之间具有临床上有意义的评分差异。较高的NIHSS评分所表明的更严重卒中与神经科医生 - RN对之间的评分不一致相关。主观评分措施，尤其是那些涉及失语患者的措施，与更大的评分不一致相关。评分差异可能归因于神经科医生和RN之间NIHSS培训要求的差异。
