An automated flowchart for the Modified Rankin Scale assessment: A multicenter inter-rater agreement analysis

Area of Science:

• Neurology
• Clinical Trials
• Digital Health

Background:

• The Modified Rankin Scale (mRS) is crucial for stroke recovery assessment but suffers from inconsistent application among clinical staff.
• This inconsistency can lead to errors in clinical practice and research.
• There is a need for standardized tools to improve mRS assessment accuracy.

Purpose of the Study:

• To develop and validate an interactive, automated digital tool named iRankin for assessing the Modified Rankin Scale.
• To enhance the congruency and accuracy of mRS scoring among healthcare professionals.

Main Methods:

• An automated flowchart was developed by vascular neurologists based on mRS literature.
• The iRankin platform included vignettes and video cases for assessing mRS grades 0-5.
• Neurological staff from six stroke centers participated in a randomized controlled trial comparing iRankin to usual practice.

Main Results:

• The iRankin tool significantly improved agreement (weighted kappa) among nurses and vascular neurologists.
• Participants using iRankin achieved higher accuracy scores in mRS assessment compared to the control group (10.6 vs. 8.2, p=0.02).
• iRankin adoption was independently associated with improved congruency scores.

Conclusions:

• The iRankin tool demonstrated substantial to near-perfect agreement across professional categories, enhancing mRS assessment.
• Further trials are recommended to generalize these findings.
• The user-friendly, free iRankin platform is accessible online.