J 2019

Inter-rater reliability between paramedics and neurologists in the assessment of severe hemiparesis in acute stroke

HOLES, D., Jiří KRÁL, M. CABAL, D. VACLAVIK, L. KLECKA et. al.

Basic information

Original name

Inter-rater reliability between paramedics and neurologists in the assessment of severe hemiparesis in acute stroke

Authors

HOLES, D. (203 Czech Republic), Jiří KRÁL (203 Czech Republic, belonging to the institution), M. CABAL (203 Czech Republic), D. VACLAVIK (203 Czech Republic), L. KLECKA (203 Czech Republic), Robert MIKULÍK (203 Czech Republic, belonging to the institution), P. JASSO (203 Czech Republic) and M. BAR (203 Czech Republic, guarantor)

Edition

Ceska a slovenska neurologie a neurochirurgie, Prague, CZECH MEDICAL SOC, 2019, 1210-7859

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30103 Neurosciences

Country of publisher

Czech Republic

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

Impact factor

Impact factor: 0.377

RIV identification code

RIV/00216224:14110/19:00112628

Organization unit

Faculty of Medicine

DOI

UT WoS

000500970200007

Keywords in English

stroke; triage; paramedics; hemiparesis; training

Tags

Tags

International impact, Reviewed
Změněno: 11/5/2020 10:45, Mgr. Tereza Miškechová

Abstract

V originále

Aim: Pre-hospital triage by paramedics could determine which patients qualify for direct transport to comprehensive stroke centres for mechanical thrombectomy. For triage to be successful, paramedics have to be able to identify major neurological impairments. The aim of our study was to determine inter-rater reliability between paramedics and stroke neurologists in identifying severe hemiparesis in acute stroke pat lents. Methods: In this prospective, multicentre study, 225 paramedics from Emergency Medical Services were taught via e-learning to distinguish between mild and severe hemiparesis. Inter-rater agreement between paramedics and stroke specialists in evaluating the degree of hemiparesis (National Institutes of Health Stroke Scale [NIHSS], items 5 and 6, scoring 0-2 [none or mild] vs. 3-4 [severe]) was assessed using the unweighted K index. Results: Over the course of 10 months in 2016, 402 consecutive patients (average age 75 years) were evaluated for the presence of hemiparesis by paramedics during pre-hospital care and by stroke neurologists immediately after stroke centre admission. The total agreement between the paramedics and neurologists in their evaluations of severe hemiparesis or monoparesis was moderate: K 0.43 (95% Cl 0.36-0.50). Conclusion: We found moderate reproducibility of the identification of severe hemiparesis in acute stroke patients when assessed by paramedics in a pre-hospital setting. Better education for paramedics is needed before implementing a change in transport triage based on their assessment of severity of neurological deficit.