Stroke scale certification
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Stroke Scale Certification: Insights and Best Practices
Introduction to NIH Stroke Scale Certification
The National Institutes of Health Stroke Scale (NIHSS) is a critical tool in modern neurology, widely used for assessing stroke severity. Over 500,000 healthcare professionals have been certified to administer it through a web-based platform1. This certification is essential for participation in clinical trials and is mandated by regulatory bodies for stroke patient care in hospitals1 2.
Importance of NIH Stroke Scale Certification
Regulatory Compliance and Clinical Trials
The NIHSS is the gold standard for stroke severity assessment, crucial for clinical trials in vascular neurology, including prevention, acute treatment, and recovery1. The Joint Commission requires an NIHSS score within 12 hours of admission for all stroke patients, emphasizing the need for certified examiners1. This requirement ensures that patient outcomes are adjusted for baseline severity, which is vital for regulatory compliance1.
Reliability Across Multiple Venues
Certification using the NIHSS has been shown to be reliable across various settings. A study involving 8,214 raters demonstrated that the certification process, whether conducted online or through other venues, maintains high reliability2. The intraclass correlation coefficient for the total score was 0.85, indicating robust reliability2. This consistency is crucial for ensuring that stroke assessments are standardized across different healthcare environments.
Training Methods for NIH Stroke Scale Certification
Video Training and Certification
Video training has proven to be an effective method for NIHSS certification. A two-camera videotape method was developed to optimize the visual presentation of examination findings, leading to moderate to excellent agreement on most scale items3. This method has been adapted for use in various studies, ensuring that all examiners rate patients comparably3.
Digital Video Disk (DVD) Training
A new training and demonstration DVD was produced to replace older videotapes, featuring 18 patients representing all possible scores on 15 scale items2 6. This DVD has been validated among both expert and general users, showing high reliability with kappa scores ranging from 0.21 to 0.92 for individual items6. The intraclass correlation coefficient for the total score was 0.94, further supporting the reliability of this training method6.
Challenges and Improvements in NIH Stroke Scale Certification
Addressing Poorly Reproducible Items
Certain items on the NIHSS, such as facial paresis and ataxia, have exhibited poor reliability3 5. To address this, a modified version of the NIHSS (mNIHSS) was developed by deleting poorly reproducible or redundant items and collapsing the sensory item into two responses5. This modified scale has shown improved reliability and validity, making it simpler to use in clinical research trials5.
Recertification and Mastery Over Time
Recertification is required annually, but data suggest that mastery of NIHSS scoring rules remains stable over time4. Technical error rates are low, and mandatory training before recertification has been shown to reduce errors, although it does not significantly improve accuracy4. This indicates that the recertification interval could be lengthened, with mandatory retraining only after unsuccessful recertifications4.
Conclusion
The NIH Stroke Scale is an indispensable tool in stroke assessment, with certification ensuring standardized and reliable use across various clinical settings. Video and DVD training methods have proven effective in maintaining high reliability among raters. While certain items on the scale may require revision for better reproducibility, the overall process of NIHSS certification remains robust. Continuous evaluation and adaptation of training methods will further enhance the reliability and effectiveness of this critical assessment tool.
Sources and full results
Most relevant research papers on this topic
Using the National Institutes of Health Stroke Scale: A Cautionary Tale
The NIHSS is a valuable tool for assessing stroke severity, but its widespread use in clinical practice requires understanding its development history, clinimetric properties, and proper bedside administration.
Rigorous Journal
Highly CitedNational Institutes of Health Stroke Scale Certification Is Reliable Across Multiple Venues
The National Institutes of Health Stroke Scale certification DVD is robust and surprisingly reliable for general users across multiple venues, with similar results between specialists and noncertified raters.
Observational StudyHighly CitedImproved Reliability of the NIH Stroke Scale Using Video Training
Video training and certification effectively standardizes the use of the NIH Stroke Scale, improving reliability in multicenter studies.
Non-RCTHighly CitedTraining and Certifying Users of the National Institutes of Health Stroke Scale
Mastery of the National Institutes of Health Stroke Scale scoring rules remains stable over time, and recertification intervals should be lengthened, with mandatory retraining only needed after unsuccessful recertifications.
Observational StudyA Modified National Institutes of Health Stroke Scale for Use in Stroke Clinical Trials: Preliminary Reliability and Validity
The mNIHSS, a modified version of the original NIHSS, shows good reliability and responsiveness in measuring acute stroke deficits in clinical trials, with potential for fewer patients and simpler use in clinical research trials.
Observational StudyHighly CitedNIHSS Training and Certification Using a New Digital Video Disk Is Reliable
The new NIHSS certification DVD is reliable for NIHSS certification, with similar reliability scores among specialists and centers, and no differences between nurses and physicians.
Observational StudyHighly CitedDevelopment of the Italian Version of the National Institutes of Health Stroke Scale: It-NIHSS
The Italian translation of the NIHSS scale, supervised by experienced vascular neurologists, did not influence its clinimetric characteristics and supports its implementation in languages other than English.
Observational StudyOutcome Measurement in Stroke: A Scale Selection Strategy
Our three-stage review process effectively selects reliable, valid, and responsive outcome measures for stroke rehabilitation studies.
Systematic Review
Very Rigorous JournalHighly CitedNIH Stroke Scale Reliability in Ratings from a Large Sample of Clinicians
The NIHSS is generally reliable for individual stroke elements, but overall scoring is inconsistent, potentially impacting clinical trial results.
Observational StudyHighly CitedEnsuring Reliability of Outcome Measures in Multicenter Clinical Trials of Treatments for Acute Ischemic Stroke: The Program Developed for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST)
A multicenter clinical trial-based educational and certification program effectively enhances physician expertise and ensures reliability of outcome measures in acute ischemic stroke trials.
Non-RCTHighly Cited