1a Letters to the Editor ABC Fax + 41 61 306 12 34 E-Mail karger@karger. ch www. karger.com © 2000 S. Karger AG, Basel Accessible online at: www. karger.com/journals/ced Cerebrovasc Dis 2000;10:80–81 Comparison of Retrospective and Prospective Measurements of the National Institutes of Health Stroke Scale A.E. Baird, J. Dashe, A. Connor, C. Burzynski, G. Schlaug, S. Warach Department of Neurology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Mass., USA For large-scale stroke studies a measure of clinical neurological severity is often needed but may not be available. This issue has recently been addressed by Goldstein and Chilukuri [1] who de- scribed a number of stroke outcome studies that were limited by the lack of such a clinical measure of clinical severity. The authors dem- onstrated that a modified version of the Canadian Neurological Scale was reliable when used to extract neurological scores from medical charts [1]. As the National Institutes of Health (NIH) Stroke Scale score developed by Brott et al. [2] has become one of the most widely used measures of neurological severity, we tested the reliability of a modified version of this scale for retrospective NIH Stroke Scale measurements. The admission neurological examinations of 23 patients admit- ted to the Neurology Service at the Beth Israel Deaconess Medical Center were reviewed by a neurologist to extract a retrospective NIH Stroke Scale score. The retrospective scores were compared with scores that had been prospectively measured in the same patients by nurses and doctors trained in the use of the NIH Stroke Scale score. The NIH Stroke Scale items were modified to correlate with features of the neurological examination as it is typically recorded. The retrospective NIH Stroke Scale scores correlated significant- ly with the NIH Stroke Scale score that had been measured prospec- tively (r = 0.945, p = 0.001, Î = 0.596, p ! 0.001, table 1). Moderate to substantial agreement was present in 12/15 items (Î 1 0.4), the highest agreement values being for orientation, commands and dys- phasia (Î 1 0.8). The items with the lowest Î values indicating fair agreement were visual fields, ataxia and sensory examination (Î = 0.2–0.4). A high intrarater reliability for the retrospective NIH Stroke Scale measurements was found (r = 0.946, p ! 0.001). The results compare favorably with values reported by Goldstein et al. [3] and Lyden et al. [4] (table 1). NIH Stroke Scale scores extracted from the charts of a neurology service are reliable and may provide a method for grading neurologi- cal deficits where prospective measurements are not available. Acknowledgments A.E.B. is supported by a Clinical Scientist Award from the Doris Duke Charitable Foundation. Table 1. Reliability measurements of NIH Stroke Scale subitems: comparison with prospectively measured NIH Stroke Scale scores NIH item Î (current study) p Î2 [3] Î3 [4] Level of consciousness 0.62 0.0002 0.50 ^ 1 0.60 1b Orientation 0.93 0.0002 0.64 1 0.60 1c Commands 0.87 0.0002 0.41 1 0.60 2 Eye movements 0.41 0.0032 0.33 1 0.60 3 Visual fields 0.33 0.0262 0.57 1 0.60 4 Facial weakness 0.68 0.0002 0.22 ! 0.40 5a Right arm drift 0.46 0.0002 0.77 ^ 0.81* 5b Right leg drift 0.88 0.0002 0.78 ^ 0.81* 6a Left arm drift 0.54 0.0002 0.77 ^ 0.81* 6b Left leg drift 0.57 0.0002 0.78 ^ 0.81* 7 Ataxia 0.22 0.123 –0.16 ! 0.40 8 Sensory loss 0.36 0.0082 0.50 1 0.60 9 Dysphasia 0.86 0.0002 0.79 0.40–0.60 10 Dysarthria 0.58 0.0002 0.32 1 0.60 11 Neglect 0.52 0.0002 0.61 1 0.60 ^ = Motor arm, motor leg; * = affected arm, affected leg. Downloaded by: Freie Universität Berlin 149.126.78.66 - 6/30/2015 7:39:21 AM