Stroke, Vol 25, 2220-2226, Copyright © 1994 by American Heart Association
P Lyden, T Brott, B Tilley, KM Welch, EJ Mascha, S Levine, EC Haley, J Grotta and J Marler
BACKGROUND AND PURPOSE: Despite the frequent use of clinical rating scales
in multicenter therapeutic stroke trials, no generally acceptable method
exists to train and certify investigators to use the instrument
consistently. We desired to train investigators to use the National
Institutes of Health Stroke Scale in a study of acute stroke therapy so
that all examiners rated patients comparably. METHODS: We devised a
two-camera videotape method that optimizes the visual presentation of
examination findings. We then measured the effectiveness of the training by
asking each investigator to evaluate a set of 11 patients, also on
videotape. We tabulated the evaluations, devised a scoring system, and
calculated measures of interobserver agreement among the participants in
this study. RESULTS: We trained and certified 162 investigators. We found
moderate to excellent agreement on most Stroke Scale items (unweighted
kappa > 0.60). Two items, facial paresis and ataxia, exhibited poor
agreement (unweighted kappa < 0.40) and should be revised in future
editions of the scale. Performance improved with video training compared
with previous studies. Inclusion of the motor rating of the unaffected
limbs in the total score did not affect reliability. CONCLUSIONS: Video
training and certification is a practical and effective method to
standardize the use of examination scales. Two cameras must be used during
the taping of patients to accurately present the clinical findings. This
method is easily adapted to any study in which a large number of
investigators will be enrolling patients at multiple clinical centers.
ARTICLES
Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group
University of California, San Diego.
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K. C. Johnston, A. F. Connors Jr, D. P. Wagner, and E. C. Haley Jr Risk Adjustment Effect on Stroke Clinical Trials Stroke, February 1, 2004; 35 (2): e43 - e45. [Abstract] [Full Text] [PDF]
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C Terborg, S Bramer, S Harscher, M Simon, and O W Witte Bedside assessment of cerebral perfusion reductions in patients with acute ischaemic stroke by near-infrared spectroscopy and indocyanine green J. Neurol. Neurosurg. Psychiatry, January 1, 2004; 75(1): 38 - 42. [Abstract] [Full Text] [PDF]
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C. A. Molina, A. V. Alexandrov, A. M. Demchuk, M. Saqqur, K. Uchino, and J. Alvarez-Sabin Improving the Predictive Accuracy of Recanalization on Stroke Outcome in Patients Treated With Tissue Plasminogen Activator Stroke, January 1, 2004; 35(1): 151 - 156. [Abstract] [Full Text] [PDF]
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K.R. Lees, D. Barer, G.A. Ford, W. Hacke, V. Kostulas, A.K. Sharma, and T. Odergren Tolerability of NXY-059 at Higher Target Concentrations in Patients With Acute Stroke Stroke, February 1, 2003; 34(2): 482 - 487. [Abstract] [Full Text] [PDF]
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S. E. Kasner, B. L. Cucchiara, M. L. McGarvey, J. M. Luciano, D. S. Liebeskind, and J. A. Chalela Modified National Institutes of Health Stroke Scale Can Be Estimated From Medical Records Stroke, February 1, 2003; 34(2): 568 - 570. [Abstract] [Full Text] [PDF]
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P. D. Schellinger, J. B. Fiebach, W. Hacke, and J. Rother Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status Stroke, February 1, 2003; 34(2): 575 - 583. [Abstract] [Full Text] [PDF]
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 A. Semplicini, A. Maresca, G. Boscolo, M. Sartori, R. Rocchi, V. Giantin, P. L. Forte, and A. C. Pessina Hypertension in Acute Ischemic Stroke: A Compensatory Mechanism or an Additional Damaging Factor? Arch Intern Med, January 27, 2003; 163(2): 211 - 216. [Abstract] [Full Text] [PDF]
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D. Schlegel;, S. J. Kolb, J. M. Luciano, J. M. Tovar, B. L. Cucchiara, D. S. Liebeskind, and S. E. Kasner Utility of the NIH Stroke Scale as a Predictor of Hospital Disposition Stroke, January 1, 2003; 34(1): 134 - 137. [Abstract] [Full Text] [PDF]
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K. C. Johnston, A. F. Connors Jr, D. P. Wagner, and E. C. Haley Jr Predicting Outcome in Ischemic Stroke: External Validation of Predictive Risk Models Stroke, January 1, 2003; 34(1): 200 - 202. [Abstract] [Full Text] [PDF]
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J. W. Sturm, R. H. Osborne, H. M. Dewey, G. A. Donnan, R. A.L. Macdonell, and A. G. Thrift Brief Comprehensive Quality of Life Assessment After Stroke: The Assessment of Quality of Life Instrument in the North East Melbourne Stroke Incidence Study (NEMESIS) Stroke, December 1, 2002; 33(12): 2888 - 2894. [Abstract] [Full Text] [PDF]
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J. Rother, P.D. Schellinger, A. Gass, M. Siebler, A. Villringer, J.B. Fiebach, J. Fiehler, O. Jansen, T. Kucinski, V. Schoder, et al. Effect of Intravenous Thrombolysis on MRI Parameters and Functional Outcome in Acute Stroke <6 Hours Stroke, October 1, 2002; 33(10): 2438 - 2445. [Abstract] [Full Text] [PDF]
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J. F. Arenillas, A. Rovira, C. A. Molina, E. Grive, J. Montaner, J. Alvarez-Sabin, and K.-O. Lovblad Prediction of Early Neurological Deterioration Using Diffusion- and Perfusion-Weighted Imaging in Hyperacute Middle Cerebral Artery Ischemic Stroke * Editorial Comment Stroke, September 1, 2002; 33(9): 2197 - 2205. [Abstract] [Full Text] [PDF]
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C. Weimar, T. Kurth, K. Kraywinkel, M. Wagner, O. Busse, R. L. Haberl, and H.-C. Diener Assessment of Functioning and Disability After Ischemic Stroke Stroke, August 1, 2002; 33(8): 2053 - 2059. [Abstract] [Full Text] [PDF]
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C. A. Molina, J. Alvarez-Sabin, J. Montaner, S. Abilleira, J. F. Arenillas, P. Coscojuela, F. Romero, and A. Codina Thrombolysis-Related Hemorrhagic Infarction: A Marker of Early Reperfusion, Reduced Infarct Size, and Improved Outcome in Patients With Proximal Middle Cerebral Artery Occlusion Stroke, June 1, 2002; 33(6): 1551 - 1556. [Abstract] [Full Text] [PDF]
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B. C. Meyer, T. M. Hemmen, C. M. Jackson, and P. D. Lyden Modified National Institutes of Health Stroke Scale for Use in Stroke Clinical Trials: Prospective Reliability and Validity Stroke, May 1, 2002; 33(5): 1261 - 1266. [Abstract] [Full Text] [PDF]
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O. Y. Bang, J. H. Heo, J. Y. Kim, J. H. Park, and K. Huh Middle Cerebral Artery Stenosis Is a Major Clinical Determinant in Striatocapsular Small, Deep Infarction Arch Neurol, February 1, 2002; 59(2): 259 - 263. [Abstract] [Full Text] [PDF]
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K. C. Johnston, D. P. Wagner, E. C. Haley Jr, and A. F. Connors Jr Combined Clinical and Imaging Information as an Early Stroke Outcome Measure Stroke, February 1, 2002; 33(2): 466 - 472. [Abstract] [Full Text] [PDF]
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P. Lyden, A. Shuaib, K. Ng, K. Levin, R.P. Atkinson, A. Rajput, L. Wechsler, T. Ashwood, L. Claesson, T. Odergren, et al. Clomethiazole Acute Stroke Study in Ischemic Stroke (CLASS-I): Final Results * Editorial Comment: Final Results Stroke, January 1, 2002; 33(1): 122 - 129. [Abstract] [Full Text] [PDF]
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 S. C. Patel, S. R. Levine, B. C. Tilley, J. C. Grotta, M. Lu, M. Frankel, E. C. Haley Jr, T. G. Brott, J. P. Broderick, S. Horowitz, et al. Lack of Clinical Significance of Early Ischemic Changes on Computed Tomography in Acute Stroke JAMA, December 12, 2001; 286(22): 2830 - 2838. [Abstract] [Full Text] [PDF]
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W.S. Burgin, L. Staub, W. Chan, PhD;, T.H. Wein, R.A. Felberg, J.C. Grotta, A.M. Demchuk, S.L. Hickenbottom, and L.B. Morgenstern Acute stroke care in non-urban emergency departments Neurology, December 11, 2001; 57(11): 2006 - 2012. [Abstract] [Full Text] [PDF]
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C. A. Molina, J. Montaner, S. Abilleira, J. F. Arenillas, M. Ribo, R. Huertas, F. Romero, and J. Alvarez-Sabin Time Course of Tissue Plasminogen Activator-Induced Recanalization in Acute Cardioembolic Stroke: A Case-Control Study Stroke, December 1, 2001; 32(12): 2821 - 2827. [Abstract] [Full Text] [PDF]
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P. Lyden, M. Jacoby, J. Schim, G. Albers, P. Mazzeo, T. Ashwood, A. Nordlund, and T. Odergren The Clomethiazole Acute Stroke Study in tissue-type plasminogen activator-treated stroke (CLASS-T): Final results Neurology, October 9, 2001; 57(7): 1199 - 1205. [Abstract] [Full Text] [PDF]
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K. Kimura, K. Minematsu, M. Koga, R. Arakawa, M. Yasaka, H. Yamagami, K. Nagatsuka, H. Naritomi, and T. Yamaguchi Microembolic Signals and Diffusion-weighted MR Imaging Abnormalities in Acute Ischemic Stroke AJNR Am. J. Neuroradiol., June 1, 2001; 22(6): 1037 - 1042. [Abstract] [Full Text] [PDF]
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P. D. Lyden, M. Lu, S. R. Levine, T. G. Brott, J. Broderick, and R. Cote A Modified National Institutes of Health Stroke Scale for Use in Stroke Clinical Trials : Preliminary Reliability and Validity Editorial Comment : The NIH Stroke Scale: Is Simpler Better? Stroke, June 1, 2001; 32(6): 1310 - 1317. [Abstract] [Full Text] [PDF]
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G. Rordorf, W. J. Koroshetz, M. A. Ezzeddine, A. Z. Segal, and F. S. Buonanno A pilot study of drug-induced hypertension for treatment of acute stroke Neurology, May 8, 2001; 56(9): 1210 - 1213. [Abstract] [Full Text] [PDF]
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C. A. Molina, J. Montaner, S. Abilleira, B. Ibarra, F. Romero, J. F. Arenillas, and J. Alvarez-Sabin Timing of Spontaneous Recanalization and Risk of Hemorrhagic Transformation in Acute Cardioembolic Stroke Stroke, May 1, 2001; 32(5): 1079 - 1084. [Abstract] [Full Text] [PDF]
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R. L. Sacco, J. T. DeRosa, E. C. Haley Jr, B. Levin, P. Ordronneau, S. J. Phillips, T. Rundek, R. G. Snipes, J. L. P. Thompson, and for the GAIN Americas Investigators Glycine Antagonist in Neuroprotection for Patients With Acute Stroke: GAIN Americas: A Randomized Controlled Trial JAMA, April 4, 2001; 285(13): 1719 - 1728. [Abstract] [Full Text] [PDF]
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K. R. Lees, A. K. Sharma, D. Barer, G. A. Ford, V. Kostulas, Y.-F. Cheng, and T. Odergren Tolerability and Pharmacokinetics of the Nitrone NXY-059 in Patients With Acute Stroke Stroke, March 1, 2001; 32(3): 675 - 680. [Abstract] [Full Text] [PDF]
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K. R. Lees, A. G. Dyker, A. Sharma, G. A. Ford, M. E. Ardron, and D. G. Grosset Tolerability of the Low-Affinity, Use-Dependent NMDA Antagonist AR-R15896AR in Stroke Patients : A Dose-Ranging Study Stroke, February 1, 2001; 32(2): 466 - 472. [Abstract] [Full Text] [PDF]
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G. Rordorf, R. J. Bellon, R. F. Budzik Jr., J. Farkas, G. F. Reinking, R. S. Pergolizzi, M. Ezzeddine, A. M. Norbash, R. Gilberto Gonzalez, and C. M. Putman Silent Thromboembolic Events Associated with the Treatment of Unruptured Cerebral Aneurysms by Use of Guglielmi Detachable Coils: Prospective Study Applying Diffusion-weighted Imaging AJNR Am. J. Neuroradiol., January 1, 2001; 22(1): 5 - 10. [Abstract] [Full Text] [PDF]
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T. Back, J. G. Hirsch, K. Szabo, and A. Gass Failure to Demonstrate Peri-Infarct Depolarizations by Repetitive MR Diffusion Imaging in Acute Human Stroke Stroke, December 1, 2000; 31(12): 2901 - 2906. [Abstract] [Full Text] [PDF]
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K. M. Chapman, A. R. Woolfenden, D. Graeb, D. C. C. Johnston, J. Beckman, M. Schulzer, and P. A. Teal Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke : A Canadian Hospital's Experience Stroke, December 1, 2000; 31(12): 2920 - 2924. [Abstract] [Full Text] [PDF]
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V. N. Thijs, M. G. Lansberg, C. Beaulieu, M. P. Marks, M. E. Moseley, and G. W. Albers Is Early Ischemic Lesion Volume on Diffusion-Weighted Imaging an Independent Predictor of Stroke Outcome? : A Multivariable Analysis Stroke, November 1, 2000; 31(11): 2597 - 2602. [Abstract] [Full Text] [PDF]
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