Comparing Emergency Medicine and Neurology Residents in Assessing Stroke Severity Using the NIHSS

Area of Science:

• Neurology
• Emergency Medicine
• Medical Education

Background:

• The National Institutes of Health Stroke Scale (NIHSS) is crucial for assessing acute stroke severity and guiding treatment.
• Emergency medicine (EM) residents often serve as primary stroke providers but lack mandatory NIHSS certification.
• Integrating NIHSS training into EM residency programs addresses this gap in preparedness.

Purpose of the Study:

• To evaluate the effectiveness of a dedicated NIHSS training and certification program for EM residents.
• To compare the NIHSS assessment skills of EM residents with neurology residents.
• To determine the impact of training on accuracy in stroke severity assessment, thrombolytic therapy indication, and large vessel occlusion (LVO) diagnosis.

Main Methods:

• An interactive, faculty-moderated NIHSS training module was implemented for all EM residents and attending physicians.
• A 6-month pilot study prospectively collected data via surveys for each acute stroke activation.
• EM and neurology residents' NIHSS assignments, thrombolytic therapy indications, and LVO diagnoses were assessed and compared using statistical analysis (Spearman's correlation, Cohen's kappa).

Main Results:

• Mean overall NIHSS scores were comparable between EM and neurology residents (6.6 vs. 6.7, p < 0.001), demonstrating substantial agreement (84.4%, κ = 0.63).
• Moderate to substantial agreement was observed for individual NIHSS scores, with the exception of horizontal extraocular movement assessment (κ = 0.30).
• Fair agreement was found for thrombolytic therapy indication (κ = 0.39), and moderate agreement for LVO diagnosis and embolization indication (κ = 0.51).

Conclusions:

• Dedicated NIHSS training effectively equipped EM residents to assess stroke severity, achieving moderate to substantial agreement in scoring.
• While overall and most individual NIHSS scores showed good agreement, focused training may further improve areas like horizontal eye movement assessment.
• Implementing focused NIHSS training for EM residents is recommended to enhance their rapid assessment capabilities for suspected stroke patients.