Development of a Novel, Weighted, Quantifiable Stroke Scale

Abstract

Background and Purpose-Several stroke scales are available for estimation of the severity of stroke, but none of them provides information regarding the relative weights of the observed variables. To define an integrated severity of stroke, we developed a quantifiable stroke scale with weighted variables that apply conjoint analysis to calculate the relative weight of each item. Methods-We selected 10 variables (consciousness, language, neglect, hemianopsia, gaze, pupillary abnormality, facial palsy, plantar reflex, sensation, and weakness) based on the multivariate analysis of the Keio Stroke Patient Database Battery. The variables were categorized and evaluated for their distribution and sensitivity. The categorizations were then modified and rechecked. The procedure was repeated until the appropriate categorization was obtained from 198 patients. A temporary stroke scale without weight was then formulated, and the reliability of the scale was examined and revised with 80 new stroke patients. As a next step, 150 neurologists were asked to rank a set of 27 virtual patients, each with a different combination of variables, according to severity. From these rankings, conjoint analysis was used to derive utility scores (weights) for each factor level. Results-The relative weights of each of the factors were as follows: consciousness 49.8%, language 9.9%, weakness of lower extremity 7.3%, pupillary abnormality 6.8%, gaze palsy 5.6%, weakness of arm 4.3%, weakness of hand 3.7%, neglect 3.7%, facial palsy 2.4%, plantar reflex 2.2%, hemianopsia 2.2%, and sensory impairment 2.1%. The total score for a patient could be calculated from the sum of the scores for each of the variables ranging from Ϫ0.38 to 27.86. Scoring of 100 patients with acute stroke was carried out, and the changes in scores were followed for validation. Longitudinal clinical monitoring of the patients correlated well with the scores in each patient. The interrater and intrarater reliabilities of the scale were excellent (weighted 0.83; Cronbach's ␣ 0.998). Conclusions-The Japan Stroke Scale is a parametric stroke scale that provides a quantitative measure of the severity of stroke. Each of the variables of the scale has a relative weight according to the severity of stroke. Reliability and responsiveness were proved to be excellent. The present data revealed a potentiality for the Japan Stroke Scale to be a universally accepted and reliable standardized system from the clinimetrical point of view. (Stroke. 2001;32:1800-1807.)

Clinical Characteristics of First-Ever Atherothrombotic Infarction or Lacunar Infarction with Hyperlipidemia (J-STARS-C): An Analysis of Data from the Stroke Data Bank of Japan

“…They were categorized as DM if they were treated with oral hypoglycemic agents or insulin, their serum fasting blood sugar level was > = 126 mg/dl or both, and HL was designated if they were taking hypolipidemic drugs, their serum cholesterol level was > = 220 mg/dl or triglyceride > = 150 mg/dl or both. The Japan Stroke Scale (JSS) (6) and National Institutes of Health Stroke Scale (NIHSS) were used to evaluate the severity of stroke on admission and on discharge, and the patient outcome was assessed using a modified Rankin scale on discharge.…”

Unassisted Assessment of Stroke Severity Using Telemedicine

“…12,19,21,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] The various items of these scales were submitted to 5 stroke neurologists (A.D.S., J.D.K., R.B., R.-J.V.H., and S.D.R. ), 2 neurolinguistic experts (P.M. and P.P.…”

Usefulness of the Japan Stroke Scale -Depression Scale- (JSS-D) for the Diagnosis of Post-stroke Depression

“…On the other hand, the Japan Stroke Scale -DepressionScale (JSS-D) (12) was prepared by the Japan Stroke Society as part of a larger system that evaluates stroke patients (13)(14)(15)(16), to assess poststroke mood disorders, including PSD (Table). The JSS-D is easier to use clinically compared with other tests for assessment of depression such as HAM-D17.…”