Validation of the National Institutes of Health Stroke Scale-8 to Detect Large Vessel Occlusion in Ischemic Stroke.

BACKGROUND: Patients with acute ischemic stroke and large vessel occlusion (LVO) may benefit from prehospital identification and transfer to a center offering endovascular therapy. AIMS: We aimed to assess the accuracy of an existing 8-item stroke scale (National Institutes of Health Stroke Scale-8 [NIHSS-8]) for identification of patients with acute stroke with LVO. METHODS: We retrospectively calculated NIHSS-8 scores in a population of consecutive patients with presumed acute stroke assessed by emergency medical services (EMS). LVO was identified on admission computed tomography angiography. Accuracy to identify LVO was calculated using receiver operating characteristics analysis. We used weighted Cohen's kappa statistics to assess inter-rater reliability for the NIHSS-8 score between the EMS and the hospital stroke team on a prospectively evaluated subgroup. RESULTS: Of the 551 included patients, 381 had a confirmed ischemic stroke and 136 patients had an LVO. NIHSS scores were significantly higher in patients with LVO (median 18; interquartile range 14-22). The NIHSS-8 score reliably predicted the presence of LVO (area under the receiver operating characteristic curve .82). The optimum NIHSS-8 cutoff of 8 or more had a sensitivity of .81, specificity of .75, and Youden index of .56 for prediction of LVO. The EMS and the stroke team reached substantial agreement (κ = .69). CONCLUSIONS: Accuracy of the NIHSS-8 to identify LVO in a population of patients with suspected acute stroke is comparable to existing prehospital stroke scales. The scale can be performed by EMS with reasonable reliability. Further validation in the field is needed to assess accuracy of the scale to identify patients with LVO eligible for endovascular treatment in a prehospital setting.

Validation of an adult ADHD measure of feigning in a sample including individuals with depression and anxiety symptoms.

Few studies of measures or techniques designed to detect feigning of Attention-Deficit/Hyperactivity Disorder (ADHD) have included groups reporting symptoms of depression and anxiety. Based on the high rate of comorbidity between ADHD and mood disorders, inclusion of such groups is important to mimic clinical referral patterns. The current study evaluated the validity of the ADHD Symptom Infrequency Scale (ASIS), a measure designed to detect malingered symptoms of ADHD, in a four-known groups design that included a group consisting of subjects with symptoms of anxiety and depression. Four groups were included in the current study: (1) control, (2) simulator, (3) ADHD diagnosed, (4) individuals with elevated symptoms of depression/anxiety. The ASIS Infrequency scale showed strong internal consistency (α = .83). Discriminant validity for the Infrequency Scale was established through a low correlation between the ASIS scale assessing feigning and a measure of anxiety and depression (r = -.02). Sensitivity was high for detection of simulation (.71), while specificity was high across comparisons, ranging from .86 to .99. Results support the ASIS as a reliable and valid measure of ADHD that is sensitive to feigning, even when including a sample of individuals reporting symptoms of depression and anxiety.

Applying the Behavior Change Technique Taxonomy to Mobile Health Applications: A Protocol.

The lack of standardized descriptors of behavior change facilitators in mobile health apps makes it difficult for clinicians and consumers to quickly evaluate the potential of a mobile health app. The Behavior Change Technique Taxonomy (BCTT) was developed to evaluate health interventions for the presence of behavior change techniques. This paper describes the methods used and methodological results in applying the BCTT to commercially available mobile health apps in the respiratory and sleep domains.

Evidence-Based Usability Principles for Safe Computerized Provider Order Entry (CPOE) Interface Design.

There is a dearth of evidence-based tools to design the safest Computerized Provider Order Entry (CPOE) system possible. An evidence-based list of usability principles for the design of the CPOE interface was developed following a literature review, and validated with the Chief Medical Information Officer and CPOE team at Island Health. The list includes 11 usability principles that can be used to inform ongoing CPOE interface design and evaluation efforts to improve patient safety.

The rural Prehospital Acute Stroke Triage (PAST) trial protocol: a controlled trial for rapid facilitated transport of rural acute stroke patients to a regional stroke centre.

RATIONALE: Access to intravenous thrombolysis for acute ischaemic stroke is limited worldwide, particularly in regional and rural areas including in Australia. We are testing the effectiveness of a new rural Prehospital Acute Stroke Triage protocol that includes prehospital assessment and rapid transport of patients from a rural catchment to the major stroke centre in Newcastle, NSW, Australia. The local district hospitals within the rural catchment do not have the capability or infrastructure to deliver acute stroke thrombolysis. The trial has relevance to stroke clinicians, health service managers and planners responsible for rural populations. AIMS: To implement a system of rapid prehospital assessment and facilitated transport that will significantly increase stroke thrombolysis rates to 10% of ischaemic stroke cases in the rural catchment. Validate an eight-point modified National Institutes of Health Stroke Scale for use by paramedics in the prehospital setting to assess patients' potential eligibility for stroke thrombolysis. DESIGN: The joint project between the John Hunter Hospital Acute Stroke Team and the Ambulance Service of NSW will use a prospective cohort with an historical control group. Tools and protocols have been developed and education undertaken for ambulance field and operations centre personnel. These include a cut-down eight-item National Institutes of Health Stroke Scale (Hunter NIHSS-8) score to be used in the field by paramedics and a transport decision matrix to expedite transport for a suspected stroke patient (road or road plus air transport). OUTCOMES: The primary outcome measure will be the rate of intravenous tissue plasminogen activator delivery for those who suffer an ischaemic stroke following protocol implementation, in comparison with historical rates over a corresponding period prior to implementation, for residents within the catchment. Sixty cases are required in the postimplementation time epoch to demonstrate a statistically significant absolute increase in thrombolysis rates for ischaemic strokes from <1% to 10%, (power of 80%, α error of 0.05). The major secondary outcome will be inter-rater reliability of the Hunter NIHSS-8.