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@article{1607100,
author = {Holes, D. and Král, Jiří and Cabal, M. and Vaclavik, D. and Klecka, L. and Mikulík, Robert and Jasso, P. and Bar, M.},
article_location = {Prague},
article_number = {4},
doi = {http://dx.doi.org/10.14735/amcsnn2019391},
keywords = {stroke; triage; paramedics; hemiparesis; training},
language = {eng},
issn = {1210-7859},
journal = {Ceska a slovenska neurologie a neurochirurgie},
title = {Inter-rater reliability between paramedics and neurologists in the assessment of severe hemiparesis in acute stroke},
url = {http://dx.doi.org/10.14735/amcsnn2019391},
volume = {82},
year = {2019}
}
TY - JOUR
ID - 1607100
AU - Holes, D. - Král, Jiří - Cabal, M. - Vaclavik, D. - Klecka, L. - Mikulík, Robert - Jasso, P. - Bar, M.
PY - 2019
TI - Inter-rater reliability between paramedics and neurologists in the assessment of severe hemiparesis in acute stroke
JF - Ceska a slovenska neurologie a neurochirurgie
VL - 82
IS - 4
SP - 391-395
EP - 391-395
PB - CZECH MEDICAL SOC
SN - 12107859
KW - stroke
KW - triage
KW - paramedics
KW - hemiparesis
KW - training
UR - http://dx.doi.org/10.14735/amcsnn2019391
L2 - http://dx.doi.org/10.14735/amcsnn2019391
N2 - 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.
ER -
HOLES, D., Jiří KRÁL, M. CABAL, D. VACLAVIK, L. KLECKA, Robert MIKULÍK, P. JASSO and M. BAR. Inter-rater reliability between paramedics and neurologists in the assessment of severe hemiparesis in acute stroke. \textit{Ceska a slovenska neurologie a neurochirurgie}. Prague: CZECH MEDICAL SOC, vol.~82, No~4, p.~391-395. ISSN~1210-7859. doi:10.14735/amcsnn2019391. 2019.
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