Interrater Reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a Multicenter Study

Abstract

Background and Purpose-Stroke is an important cause of death and disability among children. Clinical trials for childhood stroke require a valid and reliable acute clinical stroke scale. We evaluated interrater reliability (IRR) of a pediatric adaptation of the National Institutes of Health Stroke Scale. Methods-The pediatric adaptation of the National Institutes of Health Stroke Scale was developed by pediatric and adult stroke experts by modifying each item of the adult National Institutes of Health Stroke Scale for children, retaining all examination items and scoring ranges of the National Institutes of Health Stroke Scale. Children 2 to 18 years of age with acute arterial ischemic stroke were enrolled in a prospective cohort study from 15 North American sites from January 2007 to October 2009. Examiners were child neurologists certified in the adult National Institutes of Health Stroke Scale. Each subject was examined daily for 7 days or until discharge. A subset of patients at 3 sites was scored simultaneously and independently by 2 study neurologists. Results-IRR testing was performed in 25 of 113 a median of 3 days (interquartile range, 2 to 4 days) after symptom onset.Patient demographics, total initial pediatric adaptation of the National Institutes of Health Stroke Scale scores, risk factors, and infarct characteristics in the IRR subset were similar to the non-IRR subset. The 2 raters' total scores were identical in 60% and within 1 point in 84%. IRR was excellent as measured by concordance correlation coefficient of 0.97 (95% CI Key Words: childhood Ⅲ ischemic stroke Ⅲ outcome Ⅲ stroke scale Ⅲ validation I schemic stroke affects 1.2 to 7.9 per 100 000 children aged 1 month to 18 years annually in Europe and North America and ranks among the top 10 causes of death. 1,2 Long-term motor and cognitive deficits interfering with activities of daily life and academic attainment affect 40% to 60% of survivors. 3 There are no proven strategies for acute management or prevention of childhood stroke other than blood transfusion for children with sickle cell anemia. Progress in defining factors that determine outcome and designing clinical trials are hindered by the lack of a validated and reliable clinical stroke scale. Previously published cohort studies of acute clinical presentation or long-term outcome in childhood stroke have not used standardized, validated, and reliable measures of clinical stroke severity at stroke onset. The National Institutes of Health Stroke Scale (NIHSS) is a quantitative measure of stroke-related acute neurological deficit, which has proven intra-and interrater reliability (IRR) and predictive validity for outcome among adults. 4 -6 Neurological examination of children requires adjustment according to the maturation of the child's neurological and cognitive function and ability to comprehend instructions. The objective of this study was to evaluate IRR of a pediatric modification of the NIHSS, the Pediatric NIHSS (PedNIHSS), administered by child neurologists in children with ac...

Clinical and neuroimaging signs of cardioembolic stroke laboratory in children

“…Тяжесть клинических симптомов в дебюте оце-нивали при помощи педиатрической модификации шкалы инсульта Института национального здоро-вья США -PedNIHSS [19]. Интерпретацию резуль-татов PedNIHSS осуществляли по следующим кри-териям: 1-4 балла -легкий инсульт, 5-15 баллов -инсульт средней степени тяжести, 16-20 баллов -умеренно-тяжелый инсульт, 21-42 балла -тяже-лый инсульт [20].…”

Stroke in children and adolescents: a formation of a pediatric register

“…Для обследования пациентов, вошедших в регистр педиатрического инсульта, и их катамнестического на-блюдения нами была разработана программа, включаю-щая неврологический осмотр, методы нейровизуализа-ции, ультразвуковую транскраниальную допплерографию сосудов головного мозга, электроэнцефалографию, а так-же специально подобранный комплекс методов для дина-мической оценки состояния пациентов после перенесен-ного инсульта: PedNIHSS -педиатрическая шкала ин-сульта [10,11], PSOM-SNE -шкала исходов детского инсульта с оценкой неврологического статуса, версия для детей [10,12], анкета Т. Ахенбаха для родителей пациен-тов -оценка поведения, эмоциональной сферы, психо-соматических нарушений [13], исследование качества жизни.…”

“…При исследовании неврологического статуса пациентов применялась педиатрическая шкала инсульта PedNIHSS [10,11]. Сравнительная оценка состояния детей была про-ведена при выписке из стационара и на момент катамне-стического обследования через 6-9 мес после перенесен-ного инсульта.…”

Pediatric Neurocritical Care

“…This scale has demonstrated good inter-rater reliability in a multicenter study. The next step will be validation with analysis of outcome measures [129].…”