Stroke, Vol 20, 864-870, Copyright © 1989 by American Heart Association
T Brott, HP Adams Jr, CP Olinger, JR Marler, WG Barsan, J Biller, J Spilker, R Holleran, R Eberle and V Hertzberg
We designed a 15-item neurologic examination stroke scale for use in acute
stroke therapy trials. In a study of 24 stroke patients, interrater
reliability for the scale was found to be high (mean kappa = 0.69), and
test-retest reliability was also high (mean kappa = 0.66- 0.77).
Test-retest reliability did not differ significantly among a neurologist, a
neurology house officer, a neurology nurse, or an emergency department
nurse. The stroke scale validity was assessed by comparing the scale scores
obtained prospectively on 65 acute stroke patients to the patients'
infarction size as measured by computed tomography scan at 1 week and to
the patients' clinical outcome as determined at 3 months. These
correlations (scale-lesion size r = 0.68, scale-outcome r = 0.79) suggested
acceptable examination and scale validity. Of the 15 test items, the most
interrater reliable item (pupillary response) had low validity. Less
reliable items such as upper or lower extremity motor function were more
valid. We discuss methods for improving the reliability and validity of
brief examination scales to be used in stroke therapy trials.
ARTICLES
Measurements of acute cerebral infarction: a clinical examination scale
Department of Neurology, University of Cincinnati, Ohio.
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