Stroke assessment
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Clinical Assessment Tools for Acute Stroke Diagnosis
Accurate and rapid assessment is crucial in acute stroke care, especially for identifying patients eligible for time-sensitive treatments. Several clinical tools have been developed for this purpose. Tools that assess both cortical signs (such as gaze deviation, aphasia, and neglect) and motor dysfunction—like the RACE, FAST-ED, and NIHSS—demonstrate the highest diagnostic accuracy for detecting large vessel occlusion (LVO) strokes. Sensitivity and specificity for these tools vary widely, but they consistently outperform others in identifying LVO. For distinguishing stroke from stroke mimics, the FABS tool shows the best performance, though overall accuracy in this area remains modest. There is limited data on tools that can reliably differentiate between ischemic and hemorrhagic strokes, highlighting a need for further research and possibly the integration of simple imaging techniques in prehospital settings.
Functional and Outcome Assessment Scales in Stroke
Functional assessment is essential for evaluating stroke recovery and planning interventions. Commonly used scales include the National Institutes of Health Stroke Scale (NIHSS) for early prognostication and serial assessment, the modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) for overall outcome, and the Barthel Index (BI) for rehabilitation planning. The Stroke Impact Scale (SIS) captures the patient’s perspective on the effects of stroke. No single tool is suitable for all situations, so clinicians should select assessment tools based on the specific clinical or research question and the tool’s clinimetric properties26.
Multidimensional and Standardized Assessment Protocols
Standardized protocols, such as the PMIC2020, have been developed to ensure comprehensive and consistent assessment across all stages of stroke rehabilitation. These protocols include demographic, clinical, and functional variables, and incorporate validated tools for assessing malnutrition, pain, neurological impairment, activity, and participation. The use of such protocols helps identify patient needs, predict outcomes, and facilitate data collection for stroke registries58.
Prognostic Models and Recovery Prediction
Early assessment should not only evaluate current status but also predict recovery to guide intervention planning. Prognostic models and validated prediction tools are available for various domains, including motor, language, physiological, and independence functions. Incorporating these tools into clinical practice supports patient stratification and the setting of realistic therapeutic goals.
Cognitive and Bimanual Function Assessment
Cognitive assessment after stroke is recommended early in the care pathway to inform rehabilitation and discharge decisions. Clear communication about the purpose and outcomes of cognitive assessments is important for patient engagement and psychological well-being. Additionally, new tools like the Adult-Assisting Hand Assessment Stroke provide valid measures of bimanual performance, addressing a gap in traditional hand function assessments that often focus only on unimanual tasks410.
Assessment of Stroke Knowledge
Accurate assessment of stroke knowledge among patients and the public is important for prevention and management. However, most available tools lack comprehensive validation. The Stroke Knowledge Test is the most robust but still requires further development to be considered a gold standard. There is a need for more standardized and validated tools in this area79.
Conclusion
Stroke assessment is multifaceted, involving rapid diagnostic tools for acute care, functional and cognitive scales for rehabilitation, and knowledge assessments for prevention. The choice of assessment tool should be guided by the clinical context, the specific information needed, and the tool’s validated properties. Ongoing research and development of standardized protocols and prediction models continue to improve the accuracy and utility of stroke assessment across the continuum of care.
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