1/9/2024 0 Comments Opposite of retrospectiveThis can be difficult, because quality assessments and case mix adjustment are usually done from retrospective analyses of administrative databases that do not contain clinically relevant variables for measuring disease severity. Interpreting these data, particularly across institutions, requires case mix adjustment. Quality is usually inferred by linking specific structure or process of care indicators to patient-level outcomes such as mortality, length of stay, or functional outcome. There is increasing emphasis on assessing quality of care at both local and national levels. Stroke research using retrospective review of charts or of administrative databases should adjust for differences in stroke severity using such an algorithm. Agreement for individual items was moderate to high for all items except level of consciousness.Ĭonclusions-Retrospective NIHSS scoring with the algorithm is reliable and unbiased even when physical examination elements are missing from the written record. Agreement between prospective and retrospective NIHSS score was also excellent ( r 2=0.94, P<0.001) and there was no systematic bias in retrospective scores. Interrater reliability was near perfect ( r 2=0.98, P<0.001). Results-Only 1 admission note was complete for all NIHSS elements. Weighted kappa statistics were calculated to assess the level of agreement of individual NIHSS items. The Wilcoxon signed rank test was used to assess systematic scoring bias. Linear regression was used to assess interrater reliability and agreement between prospective and retrospective NIHSS scores. Two raters retrospectively scored the NIHSS by applying the algorithm to photocopied admission notes. One investigator prospectively scored the admission NIHSS in 32 consecutive stroke patients. Missing physical examination data were scored as normal. Methods-An algorithm for retrospective NIHSS scoring was developed with written history and physical admission notes. The purpose of this research was to assess the validity and reliability of an algorithm for retrospective NIHSS scoring in a setting with usual chart documentation. The NIH Stroke Scale (NIHSS) is a commonly used stroke severity measure but has been validated for retrospective scoring only in a subset of stroke clinical trial participants.
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