This Article Full Text Full Text (PDF) All Versions of this Article: 34/2/568    most recent 01.STR.0000052630.11159.25v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kasner, S. E. Articles by Chalela, J. A. Search for Related Content PubMed PubMed Citation Articles by Kasner, S. E. Articles by Chalela, J. A. Pubmed/NCBI databases Medline Plus Health Information Personal Medical Records Stroke Related Collections Health policy and outcome research Other Stroke Treatment - Medical Acute Cerebral Infarction

(Stroke. 2003;34:568.)
© 2003 American Heart Association, Inc.

Research Reports

Modified National Institutes of Health Stroke Scale Can Be Estimated From Medical Records

Scott E. Kasner, MD; Brett L. Cucchiara, MD; Michael L. McGarvey, MD; Jean M. Luciano, CRNP; David S. Liebeskind, MD Julio A. Chalela, MD

From the Department of Neurology, University of Pennsylvania Medical Center, Philadelphia.

Correspondence to Scott E. Kasner, MD, Comprehensive Stroke Center, Department of Neurology, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104. E-mail kasner{at}mail.med.upenn.edu

Abstract

Background and Purpose— The 15-item National Institutes of Health Stroke Scale (NIHSS) is a quantitative measure of stroke-related neurological deficit with established reliability and validity for use in clinical research. An abridged 11-item modified NIHSS (mNIHSS) has been described that simplifies or eliminates redundant and less reliable items. We aimed to determine whether the mNIHSS could be accurately abstracted from medical records to facilitate retrospective research.

Methods— We selected 39 patient records for which NIHSS scores were formally measured. Handwritten notes from medical records were abstracted, and NIHSS item scores were estimated by 5 raters blinded to actual scores. Estimated scores were compared among raters and with actual measured scores.

Results— Interrater reliability for total NIHSS on admission and discharge was excellent, with intraclass correlation coefficients (ICCs) of 0.85 and 0.79, respectively. However, ICCs for 2 items (facial palsy and dysarthria) were poor (<0.40). Interrater reliability for total mNIHSS was slightly greater, with ICCs of 0.87 and 0.89 on admission and discharge, respectively. None of the 11 mNIHSS items had poor reliability, 4 were moderate (ICC, 0.40 to 0.75), and 7 were excellent (ICC >0.75). Sixty-two percent of estimated total NIHSS scores were within 2 points of actual scores and 91% were within 5 points, whereas 70% of estimated total mNIHSS scores were within 2 points and 95% were within 5 points.

Conclusions— The mNIHSS can be estimated from medical records with a high degree of reliability and validity. In retrospective assessment of stroke severity, the mNIHSS performs better than the standard NIHSS and may be easier to use because it has fewer and simpler items.

Key Words: outcome • retrospective studies • stroke assessment

This article has been cited by other articles:

				A Maestroni, C Mandelli, D Manganaro, B Zecca, P Rossi, V Monzani, and G Torgano Factors influencing delay in presentation for acute stroke in an emergency department in Milan, Italy Emerg. Med. J., June 1, 2008; 25(6): 340 - 345. [Abstract] [Full Text] [PDF]

				P. Khatri, R. A. Taylor, V. Palumbo, V. Rajajee, J. M. Katz, J. A. Chalela, A. Geers, J. Haymore, D. M. Kolansky, S. E. Kasner, et al. The safety and efficacy of thrombolysis for strokes after cardiac catheterization. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 906 - 911. [Abstract] [Full Text] [PDF]

				A. I. Qureshi, J. F. Kirmani, M. A. Sayed, A. Safdar, S. Ahmed, R. Ferguson, L. A. Hershey, K. J. Qazi, and for the Buffalo Metropolitan Area and Erie County Time to hospital arrival, use of thrombolytics, and in-hospital outcomes in ischemic stroke Neurology, June 28, 2005; 64(12): 2115 - 2120. [Abstract] [Full Text] [PDF]