National Institutes of Health Stroke Scale Scoring Tool Utilizing Medical Records: A Single-Center Validation Study

Area of Science:

• Neurology
• Medical Informatics

Background:

• The National Institutes of Health Stroke Scale (NIHSS) is crucial for assessing stroke severity.
• Prospective NIHSS assessments are the gold standard but are not always available for retrospective studies.

Purpose of the Study:

• To develop and validate a retrospective NIHSS (r-NIHSS) scoring method using electronic health records.
• To integrate the Glasgow Coma Scale (GCS) and Medical Research Council (MRC) scale into the r-NIHSS for enhanced accuracy.

Main Methods:

• A structured chart-based method was developed to extract data for r-NIHSS scoring.
• Four blinded raters evaluated 50 acute ischemic stroke patients using the r-NIHSS method.
• Inter-rater reliability and agreement between r-NIHSS and prospective NIHSS (p-NIHSS) were assessed using weighted kappa and ICC.

Main Results:

• The r-NIHSS method demonstrated near-perfect agreement with p-NIHSS scores (ICC = 0.99).
• High inter-rater reliability was observed across all domains, particularly for the level of consciousness (Kw = 0.99).

Conclusions:

• The chart-based r-NIHSS method is a feasible and highly reliable tool for retrospective stroke severity assessment.
• This method provides a standardized approach for studies lacking prospective NIHSS data.