Review: Reliability of NIHSS by telemedicine

Berthier, Eric; Decavel, Pierre; Vuiller, F.; Verlut, Clotilde; Moulin, Thierry; Bustos, Elisabeth Medeiros de

doi:10.1016/j.eurtel.2012.09.001

Cited by 5 publications

(6 citation statements)

References 11 publications

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“…Therefore, in this study, reliability was calculated for each individual item of the NIHSS, which ranged from k=1.0 to k=-0.2. This study concurred with others in that whether face-to-face or telemedicine assessment is conducted, no NIHSS items consistently have very good classifications of reliability, regardless of the kappa method used (Brott et al, 1989;Lyden et al, 1994 (reference added); Goldstein and Davis, 1989;Albanese et al, 1994;Schmulling et al, 1998;Shafqat et al, 1999;Dewey et al, 1999;Handschu et al, 2003;LaMonte et al, 2004;Lyden et al, 2005;Meyer et al, 2005;Josephson et al, 2006;Meyer et al, 2008;Lyden et al, 2009;Berthier et al, 2012;Demaerschalk et al, 2012;Liman et al, 2012;Anderson et al, 2013;Berthier et al, 2013;Wu et al, 2014).…”

Section: Discussionsupporting

confidence: 86%

“…These remote assessments often use the NIHSS; however, the reliability of the NIHSS when being assessed via an audio-video link in comparison to face-to-face is not clear. Several studies have investigated the technological systems and processes of remote telemedicine assessment (Shafqat et al, 1999;Handschu et al, 2003;LaMonte et al, 2004;Meyer et al, 2005;Meyer et al, 2008;Berthier et al, 2012;Demaerschalk et al, 2012;Liman et al, 2012;Anderson et al, 2013;Berthier et al, 2013;Wu et al, 2014). However, the principal focus of these studies has been about ensuring specific remote technologies could be used, or that remote assessment could be completed in a timely manner.…”

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confidence: 99%

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Reliability of the National Institutes of Health Stroke Scale

McLoughlin

Olive

Lightbody

2022

British Journal of Neuroscience Nursing

273

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Background: The National Institutes of Health Stroke Scale (NIHSS) is widely used to measure stroke deficits and is deemed to be reliable when used by a range of professionals. Aims: This study aimed to establish the inter-rater reliability of the NIHSS when completed via telemedicine. Secondary aims were to explore if professional group, length of time since training and/or re-certification, frequency of use and reason for using the NIHSS influenced the inter-rater reliability. Methods: A total of 30 video clips, the equivalent of two whole patient assessments for each of the 15 NIHSS items, were analysed by a range of NIHSS-certified clinical participants. Of these, 10 were nurses and five were consultants. Kappa statistics were used to calculate the inter-rater reliability for each item, with additional data on the range of agreement of items. Data across group characteristics were compared to test hypotheses about factors that could impact reliability. Findings: Overall, the inter-rater reliability was found to be lower than anticipated, and there was a wide variation in ratings. Consultants tended to score better than nurses, and, counter-intuitively, stroke specialist staff and those who used the NIHSS more frequently tended to have poorer reliability than their counterparts. Total agreement on score was only achieved in five out of the 30 video clips (16.6%), with agreement better at either end of the scoring range (i.e. no deficit or worst deficit). These findings indicate that reliability of the NIHSS may be lower than anticipated. Conclusion: Further research is needed to better understand the poor reliability of the NIHSS, as this has implications for care decisions and patient outcomes.

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Section: Discussionsupporting

confidence: 86%

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confidence: 99%

Reliability of the National Institutes of Health Stroke Scale

McLoughlin

Olive

Lightbody

2022

British Journal of Neuroscience Nursing

273

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“…Though the NIHSS-telestroke examination by a neurologist using high-quality videoconferencing (HQ-VTC) is reliable [5] and recommended when the bedside assessment of such specialist is not available [6], this recommendation is based on the outcome of a few studies [7,8,9,10], which inherit systematic bias due to the subjective nature of NIHSS administration. The main sources of bias in these studies were: assessment of patients only by 2 physicians and the absence of interchange of the mode of assessment (remote or bedside) for each physician.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Remote and Bedside Assessment of the National Institute of Health Stroke Scale in Acute Stroke Patients

Алашеев¹,

Andreev²,

Gonysheva³

et al. 2017

Eur Neurol

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Introduction: Telestroke videoconference for conducting the National Institute of Health Stroke Scale (NIHSS) is recommended when the facility of a direct bedside evaluation by a stroke specialist is not immediately available for hyperacute stroke assessment. However, some NIHSS-telestroke studies inherit systematic bias due to the subjective nature of NIHSS administration. We aimed to evaluate NIHSS telestroke assessment, while implementing measures to minimize subjectivity bias. Patients and Methods: Ninety stroke patients within 48 h of onset were assessed by 6 stroke neurologists grouped in 15 pairs. Each pair of physicians assessed 6 patients. Patients were allocated through block randomization to a physician pair and order of bedside or remote assessment. Every patient was assessed once at the bedside and once remotely. Remote examination was performed by a neurologist through high-quality videoconferencing (HQ-VTC), assisted by a nurse at the patient's bedside. Kappa coefficients and the number of patients with a cumulative difference of ≤3 NIHSS points were calculated to compare bedside and remote measures. Results: Cumulative difference of ≤3 NIHSS points was observed in 85.6% (95% CI 76.6-92.1%) cases. Therefore, every fifth remote examination may have been inaccurate. Quadratically weighted kappa for total NIHSS score was 0.91 (95% CI 0.87-0.95). Minimal agreements were for commands (k = 0.46), facial palsy (k = 0.43), and ataxia (k = 0.27). Remote assessments were longer than bedside: 8 min (interquartile range, IQR 7-9) vs. 6 (IQR 5-8), p < 0.001. Conclusions: NIHSS-telestroke assessment using HQ-VTC in the acute stroke settings is closely matched with NIHSS-bedside assessment but it's credibility for clinical use needs further evaluation.

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“…Ces modalités sont fondamentales quand se posent des questions d'évaluation clinique et plus généralement pour partager rapidement tout un ensemble d'informations signifiantes. Par ailleurs, l'examen clinique neurologique simplifié dans le National Institute of Health Stroke Score (NIHSS) est reproductible et validé en télémédecine [31]. Plus important encore, est la possibilité de pouvoir orienter l'interrogatoire du patient et d'interpréter les réponses.…”

Section: Téléavc : Principes Généraux En Télémédecine Et Les Différen...unclassified