The reliability and sensitivity of the National Institutes of Health Stroke Scale for spontaneous intracerebral hemorrhage in an uncontrolled setting

The National Institutes of Health Stroke Scale (NIHSS) is commonly used to measure neurologic function and guide treatment after spontaneous intracerebral hemorrhage (ICH) in routine stroke clinics. We evaluated its reliability and sensitivity to detect change with consecutive and unique rater combi...

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Bibliographic Details
Published in:PloS one 2013-12, Vol.8 (12), p.e84702-e84702
Main Authors: Specogna, Adrian V, Patten, Scott B, Turin, Tanvir C, Hill, Michael D
Format: Article
Language:English
Subjects:
Biphenyl (Compound)
Cerebral Hemorrhage - diagnosis
Change detection
Correlation coefficient
Correlation coefficients
Health sciences
Hemorrhage
Hospitals
Humans
Intracerebral hemorrhage
Measurement methods
Medical personnel
National Institutes of Health (U.S.)
Nurses
Observer Variation
Patients
Physicians
Reliability analysis
Reproducibility of Results
Sensitivity
Sensitivity analysis
Sensitivity and Specificity
Severity of Illness Index
Stroke
Stroke - diagnosis
Studies
United States
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Summary:The National Institutes of Health Stroke Scale (NIHSS) is commonly used to measure neurologic function and guide treatment after spontaneous intracerebral hemorrhage (ICH) in routine stroke clinics. We evaluated its reliability and sensitivity to detect change with consecutive and unique rater combinations in a real-world setting. Conservative measures of interrater reliability (unweighted Kappa (κ), Intraclass Correlation Coefficient (ICC1,1) and sensitivity to detect change (Minimal Detectable Difference (MDD)) were estimated. Sixty-one repeated ratings were completed within 1 week after ICH by physicians and nurses with no investigator intervention. Reliability (consistency) of the NIHSS total score was good for both physicians vs. nurses and nurses vs. nurses (ICC=0.78, 95%CI: 0.58-0.89 and ICC=0.75, 95%CI: 0.55-0.87 respectively) in this scenario. Reliability (agreement) of items 1C and 9 were excellent (κ>=0.61) for both rater comparisons, however, reliability was poor to fair on most remaining items (κ:0.01-0.60), with item 11 being completely unreliable in this scenario (κ=10 points need to be observed for clinicians to be confident that real changes had occurred within 1 week after ICH.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0084702