title: Concurrent validity and reliability of retrospective scoring of the Pediatric National Institutes of Health Stroke Scale.
abstract: OBJECTIVE
  The Pediatric National Institutes of Health Stroke Scale (PedNIHSS), an adaptation of the adult National Institutes of Health Stroke Scale, is a quantitative measure of stroke severity shown to be reliable when scored prospectively. The ability to calculate the PedNIHSS score retrospectively would be invaluable in the conduct of observational pediatric stroke studies. The study objective was to assess the concurrent validity and reliability of estimating the PedNIHSS score retrospectively from medical records.
  
  
  METHODS
  Neurological examinations from medical records of 75 children enrolled in a prospective PedNIHSS validation study were photocopied. Four neurologists of varying training levels blinded to the prospective PedNIHSS scores reviewed the records and retrospectively assigned PedNIHSS scores. Retrospective scores were compared among raters and to the prospective scores.
  
  
  RESULTS
  Total retrospective PedNIHSS scores correlated highly with total prospective scores (R(2)=0.76). Interrater reliability for the total scores was "excellent" (intraclass correlation coefficient, 0.95; 95% CI, 0.94-0.97). Interrater reliability for individual test items was "substantial" or "excellent" for 14 of 15 items.
  
  
  CONCLUSIONS
  The PedNIHSS score can be scored retrospectively from medical records with a high degree of concurrent validity and reliability. This tool can be used to improve the quality of retrospective pediatric stroke studies.
authors.affiliation: Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Colket Translational Research Building, Philadelphia, PA 19104, USA. beslow@email.chop.edu
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beslow
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
authors.forename: Sabrina E
authors.initials: SE
authors.lastname: Smith
authors.forename: Michael T
authors.initials: MT
authors.lastname: Mullen
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Kirschen
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Bastian
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dowling
authors.forename: Warren
authors.initials: W
authors.lastname: Lo
authors.forename: Lori C
authors.initials: LC
authors.lastname: Jordan
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bernard
authors.forename: Neil
authors.initials: N
authors.lastname: Friedman
authors.forename: Gabrielle
authors.initials: G
authors.lastname: DeVeber
authors.forename: Adam
authors.initials: A
authors.lastname: Kirton
authors.forename: Lisa
authors.initials: L
authors.lastname: Abraham
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
authors.forename: Abbas F
authors.initials: AF
authors.lastname: Jawad
authors.forename: Jonas H
authors.initials: JH
authors.lastname: Ellenberg
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Ichord
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D009316:National Institutes of Health (U.S.); D015588:Observer Variation; D011153:Population; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D014481:United States
references.citation: Stroke. 2008 Sep;39(9):2644-91
references.pmid: 18635845
references.citation: Neurology. 2003 Jul 22;61(2):189-94
references.pmid: 12874397
references.citation: Stroke. 2001 Mar;32(3):656-60
references.pmid: 11239183
references.citation: Cerebrovasc Dis. 2004;17(2-3):224-7
references.pmid: 14707426
references.citation: Stroke. 2000 Apr;31(4):858-62
references.pmid: 10753988
references.citation: Cerebrovasc Dis. 2003;16(3):286-91
references.pmid: 12865618
references.citation: Stroke. 1999 Aug;30(8):1534-7
references.pmid: 10436096
references.citation: Curr Opin Pediatr. 2004 Dec;16(6):617-22
references.pmid: 15548922
references.citation: Stroke. 1989 Jul;20(7):864-70
references.pmid: 2749846
references.citation: Stroke. 1997 Feb;28(2):307-10
references.pmid: 9040680
references.citation: Neurology. 2007 May 15;68(20):1687-93
references.pmid: 17502550
references.citation: Stroke. 2011 Mar;42(3):613-7
references.pmid: 21317270
references.citation: Neurology. 1999 Jul 13;53(1):126-31
references.pmid: 10408548
references.citation: J Clin Epidemiol. 1995 Nov;48(11):1343-8
references.pmid: 7490597
references.citation: Neurology. 2003 Jul 8;61(1):71-5
references.pmid: 12847159
references.citation: Biometrics. 1977 Mar;33(1):159-74
references.pmid: 843571