Tecir Osman, Çiçek Mustafa, Çekiç Özgen Gönenç, Ardıç Şenol, Akpınar Ramazan, Usta Nuray Can, Türedi Süleyman
Department of Emergency Medicine, Akcaabat Hackali Baba State Hospital, Trabzon, Türkiye.
Department of Emergency Medicine, Kanuni Education and Research Hospital, Trabzon, Türkiye.
Turk J Emerg Med. 2025 Jul 1;25(3):223-229. doi: 10.4103/tjem.tjem_79_25. eCollection 2025 Jul-Sep.
The National Institutes of Health Stroke Scale (NIHSS) is used to determine the severity of the disease and to make treatment decisions in ischemic stroke patients. However, the need for a neurologist to assess NIHSS before thrombolytic therapy may prolong the treatment process.
This prospective, single-center, observational, planned study included patients who presented to the emergency department in the first 24 h after the onset of symptoms and were diagnosed with ischemic stroke between September 2022 and June 2023. The NIHSS was evaluated by the emergency medicine physicians and neurologists who evaluated the patients in the emergency department, and the decisions on whether to administer thrombolytics and the time taken for this decision were recorded and compared.
A very high agreement was found when the total NIHSS scores of emergency medicine physicians and neurologists were compared (intraclass correlation coefficient = 0.947 [95% confidence interval 0.92-0.96]). Emergency medicine physicians and neurologists showed high agreement with thrombolytic therapy decisions. In patients given thrombolytic therapy, emergency medicine physicians made the decision earlier than neurologists, and there was a significant difference of 14 ± 12 min between the decisions of emergency physicians and those of neurologists.
There is high agreement between emergency medicine physicians and neurologists in the NIHSS evaluation and thrombolytic decisions for patients with acute ischemic stroke. According to our results, emergency medicine physicians can provide thrombolytic treatment in accordance with neurologists, thus shortening the time for thrombolytic treatment.
美国国立卫生研究院卒中量表（NIHSS）用于确定缺血性卒中患者的疾病严重程度并做出治疗决策。然而，在溶栓治疗前需要神经科医生评估NIHSS可能会延长治疗过程。
这项前瞻性、单中心、观察性、计划性研究纳入了症状发作后24小时内就诊于急诊科且在2022年9月至2023年6月期间被诊断为缺血性卒中的患者。NIHSS由急诊科评估患者的急诊医学医生和神经科医生进行评估，并记录和比较关于是否给予溶栓治疗的决策以及做出该决策所需的时间。
比较急诊医学医生和神经科医生的NIHSS总分时发现一致性非常高（组内相关系数 = 0.947 [95%置信区间0.92 - 0.96]）。急诊医学医生和神经科医生在溶栓治疗决策上显示出高度一致性。在接受溶栓治疗的患者中，急诊医学医生比神经科医生更早做出决策，急诊医生和神经科医生的决策之间存在14±12分钟的显著差异。
急诊医学医生和神经科医生在急性缺血性卒中患者的NIHSS评估和溶栓决策方面具有高度一致性。根据我们的结果，急诊医学医生可以按照神经科医生的意见提供溶栓治疗，从而缩短溶栓治疗时间。
