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Stroke severity quantification by critical care physicians in a mobile stroke unit.

Maren R Hov1,2, Jo Røislien1,3, Thomas Lindner1,4

  • 1Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak.

European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine
|December 15, 2017
PubMed
Summary

The National Institute of Health Stroke Scale (NIHSS) can be accurately used by critical care physicians in mobile stroke units for acute stroke assessment. Discrepancies in scores were minor and did not alter patient management.

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Clinical Diagnostics

Background:

  • Accurate diagnostic tools are crucial for timely cerebral revascularization in acute stroke.
  • The National Institute of Health Stroke Scale (NIHSS) is standard for in-hospital stroke assessment.
  • Prehospital stroke scales are typically less specific than the NIHSS.

Purpose of the Study:

  • To evaluate the accuracy and clinical utility of the NIHSS when applied in the prehospital setting.
  • To compare prehospital NIHSS scores with in-hospital assessments by neurologists.

Main Methods:

  • Thirteen anesthesiologists in a mobile stroke unit administered the NIHSS to suspected acute stroke patients.
  • NIHSS was performed twice: once prehospital and once by a neurologist at the hospital.
  • Agreement was assessed using Bland-Altman plots and Cohen's κ for clinical categories.

Main Results:

  • The mean difference between prehospital and in-hospital NIHSS scores was 0.85 (limits of agreement: -5.94 to 7.64).
  • Inter-rater agreement for clinical categories was moderate (κ = 0.38).
  • Prehospital workup including NIHSS and CT scan was completed in a median of 10 minutes.

Conclusions:

  • The NIHSS is a viable clinical tool for critical care physicians in mobile stroke units for acute stroke assessment.
  • Score disagreements were primarily at low values and did not impact patient management decisions.
  • Prehospital NIHSS use shows potential for improving acute stroke care coordination.