Abstract TP65: An Automated Algorithm For The Nih Stroke Scale Assessment

Abstract

The NIH Stroke Scale (NIHSS) is widely adopted in clinical practice. Despite being originally designed for research use, the NIHSS is a valued resource for communication and prognostication, and it is useful for the decision-making process regarding reperfusion therapies and prophylaxis. However, its assessment can be laborious and complex among even certified healthcare providers. In the context of increasing telemedicine use, an accurate assessment of the NIHSS may be crucial in acute stroke management We aimed to create and validate an automated tool for the NIHSS (SPOKES) in a national telemedicine service. A board of five certified vascular neurologists created an NIHSS algorithm based on a tree decision, including tips and hints in the main questions and auxiliary boxes. We randomized 22 spoke hospitals using an automated tool to invite emergency physicians not certified in the NIHSS to use or not the SPOKES. NIHSS-certified and blinded neurologists from a hub hospital performed a double-check of each item of the NIHSS. From June to August 2022, we included 144 cases from 10 spoke hospitals. Our algorithm was fully adopted in 27 cases (19%). The median of reported NIHSS was 3 [1, 5] and 3 [2, 7] points among users and non-users, p=0.38. The general difference between the reported and the double-checked score was 0 [0, 1] points – there was no difference between those who used or did not the SPOKES (p=0.12). A complete concordant score was achieved at 66.7% (n=18/27) and 45.3% (n=53/117), χ 2 =0.036, among users and non-users, respectively. In a bivariate regression analysis, the SPOKES increased the chance of complete agreement [OR 2.4, 95%CI 1-5.8, p=0.049]. There was no difference regarding discrepant scores (≥4 points), χ 2 =0.46. Among SPOKES cases, treatment with tPA was indicated in 11.1%, versus 12.7% among non-users (p=0.59). Despite the small number of included cases, our algorithm seems to be a promising tool for the NIHSS assessment in a national telemedicine service, increasing the chance of a complete agreement with certified neurologists. The tool is free and available at www.spokes-nihss.com