Abstract
OBJECTIVE:We aimed to determine the reliability of the NIHSS between emergency department (ED) physicians and neurologists in a clinical, non-trial setting for cases of acute ischemic stroke (AIS) from the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) for the calendar year 2010 study period. BACKGROUND:Reliability of the National Institutes of Health Stroke Scale (NIHSS) between trained neurologists and trained non-neurologists in context of a clinical trial has previously been established. DESIGN/METHODS:We identified all AIS patients > 20 years old among residents of the GCNK region who presented to an ED in 2010 by screening ICD-9 hospital discharge codes. For patients whose neurologic deficits remained static (i.e., neither improved nor worsened) between ED assessment and first neurologist assessment we compared the overall NIHSS and its individual components. Most ED NIHSS items were done retrospectively. The nurse/abstractor estimated the values for the NIHSS items according to information found in the history/physical. Interrater reliability was assessed using weighted kappa and intraclasss correlation (ICC). RESULTS:Of 2035 AIS patients who presented to an ED, 340 met criteria for this analysis. Median time between ED and neurologist NIHSS was 26 hours (IQR 2-32). Weighted kappa statistics showed excellent agreement (kappa 蠅 0.7) for LOC questions and language; poor agreement (kappa < 0.4) for the components of gaze, visual fields, ataxia, sensory, and extinction; and the rest were moderate. The ICC between ED physician and neurologist for the total NIHSS was 0.82. CONCLUSIONS:Overall, there was excellent agreement in total NIHSS between ED physicians and neurologist. The NIHSS components gaze, visual fields, ataxia, sensory, and extinction are areas improvement of assessment and documentation in the ED, and should be specifically evaluated in AIS patients whose scores are considered too mild for rt-PA eligibility. Study Supported by:
Disclosure: Dr. Katz has nothing to disclose. Dr. Khoury has nothing to disclose. Dr. Alwell has nothing to disclose. Dr. Moomaw has received research support from the National Institutes of Health. Dr. Kleindorfer has received personal compensation for activities with Genentech.
Wednesday, April 22 2015, 2:00 pm-6:30 pm
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