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Methods for stroke severity assessment by chart review in the Atherosclerosis Risk in Communities study
Silvia Koton1,2, Shalom Patole3, Julia M Carlson4
1Sackler Faculty of Medicine, The Herczeg Institute on Aging and The Stanley Steyer School of Health Professions, Tel Aviv University, 6997801, Tel Aviv, Israel. koton@tauex.tau.ac.il.
Scientific Reports
|July 19, 2022
Summary
Retrospectively assessing stroke severity using the National Institutes of Health Stroke Scale (NIHSS) from hospital charts is feasible and reliable. This method provides valuable data for understanding stroke outcomes and risk factors in large studies.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Stroke severity is a key predictor of post-stroke outcomes.
- Longitudinal studies often lack direct stroke severity measures.
- Accurate severity assessment can improve understanding of stroke outcomes and risk factors.
Purpose of the Study:
- To outline and validate a method for retrospective stroke severity assessment using hospital charts.
- To establish stroke severity data in the Atherosclerosis Risk in Communities (ARIC) study.
- To provide a model for stroke severity assessment in large epidemiologic studies.
Main Methods:
- Trained physicians abstracted data from hospital charts for ischemic stroke events in the ARIC study.
- Stroke severity was categorized using the National Institutes of Health Stroke Scale (NIHSS) into five levels.
- Interrater reliability was assessed on a subset of stroke events.
Main Results:
- Chart-based NIHSS assessment was possible for 97% of ischemic stroke events.
- High interrater reliability was observed for both continuous NIHSS scores (Pearson r=0.90) and categorized severity (Cohen's weighted Kappa=0.79).
- The majority of strokes were classified as minor (NIHSS ≤ 5, 58.3%).
Conclusions:
- Retrospective assessment of stroke severity using the NIHSS from hospital charts is feasible and reliable.
- This methodology can be effectively applied in large epidemiologic studies.
- The findings support the use of chart-based NIHSS for evaluating stroke severity and its associations.