Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study

Rebecca N. Ichord, Rachel Bastian, Lisa Abraham, Rand Askalan, Susan Benedict, Timothy J. Bernard, Lauren Beslow, Gabrielle DeVeber, Michael Dowling, Neil Friedman, Heather Fullerton, Lori Jordan, Li Kan, Adam Kirton, Catherine Amlie-Lefond, Daniel Licht, Warren Lo, Chalmer McClure, Steve Pavlakis, Sabrina E. Smith & 3 others Marilyn Tan, Scott Kasner, Abbas F. Jawad

Research output: Contribution to journalArticle

60 Citations (Scopus)

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, 0.94 to 0.99); intraclass correlation coefficient of 0.99 (95% CI, 0.97 to 0.99); precision measured by Pearson ρ of 0.97; and accuracy measured by the bias correction factor of 1.0. CONCLUSIONS - There was excellent IRR of the pediatric adaptation of the National Institutes of Health Stroke Scale in a multicenter prospective cohort performed by trained child neurologists.

Original languageEnglish (US)
Pages (from-to)613-617
Number of pages5
JournalStroke
Volume42
Issue number3
DOIs
StatePublished - Mar 2011

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National Institutes of Health (U.S.)
Multicenter Studies
Stroke
Pediatrics
Cause of Death
Cohort Studies
Demography
Clinical Trials
Prospective Studies

Keywords

  • childhood
  • ischemic stroke
  • outcome
  • stroke scale
  • validation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Ichord, R. N., Bastian, R., Abraham, L., Askalan, R., Benedict, S., Bernard, T. J., ... Jawad, A. F. (2011). Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study. Stroke, 42(3), 613-617. https://doi.org/10.1161/STROKEAHA.110.607192

Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study. / Ichord, Rebecca N.; Bastian, Rachel; Abraham, Lisa; Askalan, Rand; Benedict, Susan; Bernard, Timothy J.; Beslow, Lauren; DeVeber, Gabrielle; Dowling, Michael; Friedman, Neil; Fullerton, Heather; Jordan, Lori; Kan, Li; Kirton, Adam; Amlie-Lefond, Catherine; Licht, Daniel; Lo, Warren; McClure, Chalmer; Pavlakis, Steve; Smith, Sabrina E.; Tan, Marilyn; Kasner, Scott; Jawad, Abbas F.

In: Stroke, Vol. 42, No. 3, 03.2011, p. 613-617.

Research output: Contribution to journalArticle

Ichord, RN, Bastian, R, Abraham, L, Askalan, R, Benedict, S, Bernard, TJ, Beslow, L, DeVeber, G, Dowling, M, Friedman, N, Fullerton, H, Jordan, L, Kan, L, Kirton, A, Amlie-Lefond, C, Licht, D, Lo, W, McClure, C, Pavlakis, S, Smith, SE, Tan, M, Kasner, S & Jawad, AF 2011, 'Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study', Stroke, vol. 42, no. 3, pp. 613-617. https://doi.org/10.1161/STROKEAHA.110.607192
Ichord, Rebecca N. ; Bastian, Rachel ; Abraham, Lisa ; Askalan, Rand ; Benedict, Susan ; Bernard, Timothy J. ; Beslow, Lauren ; DeVeber, Gabrielle ; Dowling, Michael ; Friedman, Neil ; Fullerton, Heather ; Jordan, Lori ; Kan, Li ; Kirton, Adam ; Amlie-Lefond, Catherine ; Licht, Daniel ; Lo, Warren ; McClure, Chalmer ; Pavlakis, Steve ; Smith, Sabrina E. ; Tan, Marilyn ; Kasner, Scott ; Jawad, Abbas F. / Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study. In: Stroke. 2011 ; Vol. 42, No. 3. pp. 613-617.
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AU - Abraham, Lisa

AU - Askalan, Rand

AU - Benedict, Susan

AU - Bernard, Timothy J.

AU - Beslow, Lauren

AU - DeVeber, Gabrielle

AU - Dowling, Michael

AU - Friedman, Neil

AU - Fullerton, Heather

AU - Jordan, Lori

AU - Kan, Li

AU - Kirton, Adam

AU - Amlie-Lefond, Catherine

AU - Licht, Daniel

AU - Lo, Warren

AU - McClure, Chalmer

AU - Pavlakis, Steve

AU - Smith, Sabrina E.

AU - Tan, Marilyn

AU - Kasner, Scott

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N2 - 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, 0.94 to 0.99); intraclass correlation coefficient of 0.99 (95% CI, 0.97 to 0.99); precision measured by Pearson ρ of 0.97; and accuracy measured by the bias correction factor of 1.0. CONCLUSIONS - There was excellent IRR of the pediatric adaptation of the National Institutes of Health Stroke Scale in a multicenter prospective cohort performed by trained child neurologists.

AB - 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, 0.94 to 0.99); intraclass correlation coefficient of 0.99 (95% CI, 0.97 to 0.99); precision measured by Pearson ρ of 0.97; and accuracy measured by the bias correction factor of 1.0. CONCLUSIONS - There was excellent IRR of the pediatric adaptation of the National Institutes of Health Stroke Scale in a multicenter prospective cohort performed by trained child neurologists.

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