title: Deriving modified Rankin scores from medical case-records.
abstract: OBJECTIVE
  Modified Rankin score (mRS) is traditionally graded using a face-to-face or telephone interview. Certain stroke assessment scales can be derived from a review of a patient's case-record alone. We hypothesized that mRS could be successfully derived from the narrative within patient case-records.
  
  
  METHODS
  Sequential patients attending our cerebrovascular outpatient clinic were included. Two independent, blinded clinicians, trained in mRS, assessed case-records to derive mRS. They scored "certainty" of their grading on a 5-point Likert scale. Agreement between derived and traditional face-to-face mRS was calculated using attribute agreement analysis.
  
  
  RESULTS
  Fifty patients with a range of disabilities were included. Case-record appraisers were poor at deriving mRS (k=0.34 against standard). Derived mRS grades showed poor agreement between observers (k=0.33). There was no relationship between certainty of derived mRS and proportion of correct grades (P=0.727).
  
  
  CONCLUSIONS
  Accurate mRS cannot be derived from standard hospital records. Direct mRS interview is still required for clinical trials.
authors.affiliation: Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. Tjq1t@clinmed.gla.ac.uk
authors.forename: Terence J
authors.initials: TJ
authors.lastname: Quinn
authors.forename: Gautamananda
authors.initials: G
authors.lastname: Ray
authors.forename: Sari
authors.initials: S
authors.lastname: Atula
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Walters
authors.forename: Jesse
authors.initials: J
authors.lastname: Dawson
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015588:Observer Variation; D010045:Outpatients / Q000523:psychology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis*; D014741:Video Recording