title: Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurology, Children's Hospital of Philadelphia, Colket Translational Research Building 10th Floor, 3501 Civic Center Blvd, Philadelphia, PA 19104, USA. ichord@email.chop.edu
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Ichord
authors.forename: Rachel
authors.initials: R
authors.lastname: Bastian
authors.forename: Lisa
authors.initials: L
authors.lastname: Abraham
authors.forename: Rand
authors.initials: R
authors.lastname: Askalan
authors.forename: Susan
authors.initials: S
authors.lastname: Benedict
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bernard
authors.forename: Lauren
authors.initials: L
authors.lastname: Beslow
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Deveber
authors.forename: Michael
authors.initials: M
authors.lastname: Dowling
authors.forename: Neil
authors.initials: N
authors.lastname: Friedman
authors.forename: Heather
authors.initials: H
authors.lastname: Fullerton
authors.forename: Lori
authors.initials: L
authors.lastname: Jordan
authors.forename: Li
authors.initials: L
authors.lastname: Kan
authors.forename: Adam
authors.initials: A
authors.lastname: Kirton
authors.forename: Catherine
authors.initials: C
authors.lastname: Amlie-Lefond
authors.forename: Daniel
authors.initials: D
authors.lastname: Licht
authors.forename: Warren
authors.initials: W
authors.lastname: Lo
authors.forename: Chalmer
authors.initials: C
authors.lastname: McClure
authors.forename: Steve
authors.initials: S
authors.lastname: Pavlakis
authors.forename: Sabrina E
authors.initials: SE
authors.lastname: Smith
authors.forename: Marilyn
authors.initials: M
authors.lastname: Tan
authors.forename: Scott
authors.initials: S
authors.lastname: Kasner
authors.forename: Abbas F
authors.initials: AF
authors.lastname: Jawad
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009316:National Institutes of Health (U.S.) / Q000592:standards*; D015588:Observer Variation; D010865:Pilot Projects; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology