改良朗肯量表评估自动流程图:多中心评分者间一致性分析。

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY
International Journal of Stroke Pub Date : 2024-08-01 Epub Date: 2024-04-18 DOI:10.1177/17474930241246157
Joao Brainer C de Andrade, Terence J Quinn, Leonardo Augusto Carbonera, Vinicius Viana Abreu Montanaro, Alexandre C Robles, Rafael Pádua Gomes, Saulo Ribeiro, Gisele Sampaio Silva
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引用次数: 0

摘要

背景和目的:改良 Rankin 量表(mRS)是一种广泛采用的评估卒中恢复情况的量表。尽管存在局限性,但最近大多数急性卒中临床试验都采用 mRS 作为主要结果。该量表旨在供多学科临床人员使用,但其一致性并不一致,这可能导致临床或研究应用中的失误。我们的目标是开发并验证一种用于评估 mRS 的交互式自动数字工具 - iRankin:方法:由五位获得董事会认证并接受过 mRS 培训的血管神经学家组成的小组根据当前的 mRS 文献开发了一个自动流程图。两位国际专家就原型平台的内容接受了咨询并提供了反馈意见。该平台包含五个小故事和五个真实视频病例,分别代表 mRS 0-5 级。为了进行验证,我们邀请了六家综合卒中中心的神经科员工完成在线评估。参与者被随机分为两组,组别相同,分别为通常做法组和 iRankin 组。参与者随机分配成对进行一致性分析。加权卡帕(kw)和比例用于描述一致性:共有 59 名专业人员完成了评估。护士的加权卡帕值为 0.76 (95% CI 0.55-0.97) x 0.30 (0.07-0.67),血管神经科医生的加权卡帕值为 0.87 (0.72-1) x 0.82 (0.66-0.98)。在准确性分析中,专家小组确定了小故事和视频的标准 mRS 值,并将每个正确答案视为相当于 0-15 分中的 1 分,结果显示 iRankin 组的平均值为 10.6(±2.2)分,对照组为 8.2(±2.3)分(P=0.02)。在调整分析中,采用 iRankin 与报告分数和标准分数之间的一致性得分有独立关联(贝塔系数 2.22,95% CI 0.64-3.81,p 值= 0.007):采用 iRankin 后,在所有分析的专业类别中都取得了实质性或接近完美的一致。要推广我们的研究结果,还需要更多的试验。我们的用户友好型免费平台可在 www.irankinscale.com 上获取。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An automated flowchart for the Modified Rankin Scale assessment: A multicenter inter-rater agreement analysis.

Background and objective: The Modified Rankin Scale (mRS) is a widely adopted scale for assessing stroke recovery. Despite limitations, the mRS has been adopted as primary outcome in most recent clinical acute stroke trials. Designed to be used by multidisciplinary clinical staff, the congruency of this scale is not consistent, which may lead to mistakes in clinical or research application. We aimed to develop and validate an interactive and automated digital tool for assessing the mRS-the iRankin.

Methods: A panel of five board-certified and mRS-trained vascular neurologists developed an automated flowchart based on current mRS literature. Two international experts were consulted on content and provided feedback on the prototype platform. The platform contained five vignettes and five real video cases, representing mRS grades 0-5. For validation, we invited neurological staff from six comprehensive stroke centers to complete an online assessment. Participants were randomized into two equal groups usual practice versus iRankin. The participants were randomly allocated in pairs for the congruency analysis. Weighted kappa (kw) and proportions were used to describe agreement.

Results: A total of 59 professionals completed the assessment. The kw was dramatically improved among nurses, 0.76 (95% confidence interval (CI) = 0.55-0.97) × 0.30 (0.07-0.67), and among vascular neurologists, 0.87 (0.72-1) × 0.82 (0.66-0.98). In the accuracy analysis, after the standard mRS values for the vignettes and videos were determined by a panel of experts, and considering each correct answer as equivalent to 1 point on a scale of 0-15, it revealed a higher mean of 10.6 (±2.2) in the iRankin group and 8.2 (±2.3) points in the control group (p = 0.02). In an adjusted analysis, the iRankin adoption was independently associated with the score of congruencies between reported and standard scores (beta coefficient = 2.22, 95% CI = 0.64-3.81, p = 0.007).

Conclusion: The iRankin adoption led to a substantial or near-perfect agreement in all analyzed professional categories. More trials are needed to generalize our findings. Our user-friendly and free platform is available at https://www.irankinscale.com/.

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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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