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The NIH Stroke Scale Lacks Validity in Chronic Hemiparetic Stroke
Research Posters Research Poster 3416 An Empirical Classification Scheme for Detection of Impossible and Improbable CRS-R Subscore Combinations Camille Chatelle, Yelena Bodien (Spaulding Rehabilitation Hospital), Cecilia Carlowicz, Steven Laureys, Joseph Giacino Objective(s): The Coma Recovery Scale-Revised (CRS-R) is a standardized neurobehavioral measure designed for use in diagnostic and prognostic assessment in patients with disorders of consciousness (DOC). The aims of this study are to determine the probability with which specific CRS-R subscale score combinations occur and to provide clinicians and researchers with a method of determining impossible or improbable scores. Design: Retrospective data analysis from three databases including patients admitted to hospitals in the United States and Belgium. Setting: Specialized inpatient DOC Program and university hospitals. Participants: 869 patients diagnosed with DOC (569 male, mean age Z 47y, standard deviationZ20y, time since insultZ 240815 days). Interventions: N/A. Main Outcome Measure(s): Impossible score combinations were defined as two scores that cannot co-occur based on standard scoring guidelines. To determine improbable score combinations, we calculated the Mahalanobis distance for each pair of subscores (e.g., visual subscore of 1 and motor subscore of 2) and conducted a chi square analysis to determine the p value associated with the distance of each pair from the centroid. We then classified score combinations as “improbable” (p<0.05) and “very improbable” (p<0.02). Results: Of the 869 CRS-R profiles analyzed, 8.5% were excluded because they met impossible scoring criteria. Among the 796 remaining profiles, 7% (24/330) of subscale score pairs were classified as improbable and 18% (60/330) very improbable (e.g., functional object use co-occurring with auditory startle). Conclusions: An empirically-derived classification scheme can be used to determine the validity and probability of CRS-R subscore combinations. This methodology can be applied in data quality analysis and may have diagnostic utility in clinical practice. Key Words: Consciousness, Classification, Research design Disclosure(s): None Disclosed.
Research Poster 3425 Deployment-related Rehospitalizations following TBI: A VA TBI Model Systems Study Johanna Tran (James A Haley Veterans’ Hospital), Risa NakaseRichardson, Blessen C. Eapen, Steven Scott, Marissa McCarthy, Margaret Schmitt Objective(s): To investigate the frequency and nature of rehospitalization in the first year post deployment and non-deployment related TBI. Design: Multi-center prospective observational study using the VA TBI Model System (TBIMS) dataset. Setting: Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs). Participants: Study sample consisted of 395 Veterans and Active Duty Service Members who were primarily male (96%) with a median age of 27. Injuries were primarily severe (median GCS Z8) with smaller subset of mild (38%) and moderate (10%) injuries. Primary cause of injury was motor-vehicle related (45%), blast (26%), and fall (11%). Interventions: None. Main Outcome Measure(s): Frequency and cause of rehospitalization in the first year post-TBI.
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e35 Results: Of 627 VA TBIMS enrolled participants, 397 met study criteria. Thirty-six percent sustained TBI during deployment. Twohundred and fifty rehospitalizations occurred within the first year postinjury. Deployment-related TBI was associated with more frequent rehospitalizations (ÐœZ2.2, SD 3.4) compared to non-deployment TBI (MZ1.18, SD 2.4; FZ (1, 393), 12.54, p>.001). Primary causes of rehospitalization were similar across both groups (i.e., rehabilitation, other, orthopedic, infections, seizures, psychiatric and general health); however, deployment-related TBI was associated with significantly more orthopedic admissions (tZ2.2, pZ.026). A linear regression model using age, GCS, TBI etiology, and time to rehabilitation admission was not significant in predicting number of rehospitalizations. Conclusions: Chronic rehabilitation and health care needs of Veterans and Active Duty Service Members are understudied. This study highlights frequent rehospitalization with deployment related TBI with more frequent orthopedic admissions. Predictors of rehospitalization remain poorly understood; however, a high index of suspicion for orthopedic injuries, subclinical infection, and seizure in its various presentations may help prevent morbidity in chronic stages of TBI. Key Words: Brain injuries, Veterans, Patient readmission Disclosure(s): None Disclosed. Research Poster 3433 The NIH Stroke Scale Lacks Validity in Chronic Hemiparetic Stroke Heather Tanksley Peters (The Ohio State University), Susan White, Stephen Page Objective(s): To investigate the concurrent validity of the NIH Stroke Scale with the Stroke Impact Scale (SIS), a previously validated measure of health status in chronic stroke survivors. Design: Secondary analysis of data collected pre-intervention from a multicenter randomized controlled trial. Setting: Outpatient rehabilitation facilities across the United States. Participants: 147 chronic stroke patients. Interventions: N/A. Main Outcome Measure(s): The NIHSS and SIS were administered preintervention as part of the aforementioned trial. A Spearman’s Rho was used to determine correlations between NIHSS total score and (a) SIS physical dimension scores (b) SIS overall perception of recovery scores (c) the SIS ADL/IADL scores. SIS score variation and medians between subjects who scored a zero versus a nonzero on the NIHSS was also assessed. Results: There was no association between total NIHSS scores and SIS physical dimension scores, SIS overall perception of recovery scores and SIS ADL/IADL scores (PZ -.036, pZ.782, PZ-.039, pZ.640, PZ-.054, pZ.520, respectively). Lastly, significant variation as well as similar median scores on the SIS were found between those scoring a zero on the NIHSS versus those who did not score a zero. Conclusions: The NIHSS is being increasingly used in chronic rehabilitative trials necessitating an investigation of its validity in this burgeoning population. Our data indicates that the NIHSS has no association with health status in chronic stroke and lacks association with measures of impairment and functional limitation. From these findings, we conclude that the NIHSS has poor validity to discern post stroke outcomes, and is not associated with health status. Due to possible limitation in the NIHSS’s ability to accurately measure impairment in this population, we recommend restriction of its use to evaluation of stroke severity in the acute stage of recovery. Key Words: Stroke, Rehabilitation, Outcomes Disclosure(s): None Disclosed.
Research Poster 3425 Deployment-related Rehospitalizations following TBI: A VA TBI Model Systems Study Johanna Tran (James A Haley Veterans’ Hospital), Risa NakaseRichardson, Blessen C. Eapen, Steven Scott, Marissa McCarthy, Margaret Schmitt Objective(s): To investigate the frequency and nature of rehospitalization in the first year post deployment and non-deployment related TBI. Design: Multi-center prospective observational study using the VA TBI Model System (TBIMS) dataset. Setting: Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs). Participants: Study sample consisted of 395 Veterans and Active Duty Service Members who were primarily male (96%) with a median age of 27. Injuries were primarily severe (median GCS Z8) with smaller subset of mild (38%) and moderate (10%) injuries. Primary cause of injury was motor-vehicle related (45%), blast (26%), and fall (11%). Interventions: None. Main Outcome Measure(s): Frequency and cause of rehospitalization in the first year post-TBI.
www.archives-pmr.org
e35 Results: Of 627 VA TBIMS enrolled participants, 397 met study criteria. Thirty-six percent sustained TBI during deployment. Twohundred and fifty rehospitalizations occurred within the first year postinjury. Deployment-related TBI was associated with more frequent rehospitalizations (ÐœZ2.2, SD 3.4) compared to non-deployment TBI (MZ1.18, SD 2.4; FZ (1, 393), 12.54, p>.001). Primary causes of rehospitalization were similar across both groups (i.e., rehabilitation, other, orthopedic, infections, seizures, psychiatric and general health); however, deployment-related TBI was associated with significantly more orthopedic admissions (tZ2.2, pZ.026). A linear regression model using age, GCS, TBI etiology, and time to rehabilitation admission was not significant in predicting number of rehospitalizations. Conclusions: Chronic rehabilitation and health care needs of Veterans and Active Duty Service Members are understudied. This study highlights frequent rehospitalization with deployment related TBI with more frequent orthopedic admissions. Predictors of rehospitalization remain poorly understood; however, a high index of suspicion for orthopedic injuries, subclinical infection, and seizure in its various presentations may help prevent morbidity in chronic stages of TBI. Key Words: Brain injuries, Veterans, Patient readmission Disclosure(s): None Disclosed. Research Poster 3433 The NIH Stroke Scale Lacks Validity in Chronic Hemiparetic Stroke Heather Tanksley Peters (The Ohio State University), Susan White, Stephen Page Objective(s): To investigate the concurrent validity of the NIH Stroke Scale with the Stroke Impact Scale (SIS), a previously validated measure of health status in chronic stroke survivors. Design: Secondary analysis of data collected pre-intervention from a multicenter randomized controlled trial. Setting: Outpatient rehabilitation facilities across the United States. Participants: 147 chronic stroke patients. Interventions: N/A. Main Outcome Measure(s): The NIHSS and SIS were administered preintervention as part of the aforementioned trial. A Spearman’s Rho was used to determine correlations between NIHSS total score and (a) SIS physical dimension scores (b) SIS overall perception of recovery scores (c) the SIS ADL/IADL scores. SIS score variation and medians between subjects who scored a zero versus a nonzero on the NIHSS was also assessed. Results: There was no association between total NIHSS scores and SIS physical dimension scores, SIS overall perception of recovery scores and SIS ADL/IADL scores (PZ -.036, pZ.782, PZ-.039, pZ.640, PZ-.054, pZ.520, respectively). Lastly, significant variation as well as similar median scores on the SIS were found between those scoring a zero on the NIHSS versus those who did not score a zero. Conclusions: The NIHSS is being increasingly used in chronic rehabilitative trials necessitating an investigation of its validity in this burgeoning population. Our data indicates that the NIHSS has no association with health status in chronic stroke and lacks association with measures of impairment and functional limitation. From these findings, we conclude that the NIHSS has poor validity to discern post stroke outcomes, and is not associated with health status. Due to possible limitation in the NIHSS’s ability to accurately measure impairment in this population, we recommend restriction of its use to evaluation of stroke severity in the acute stage of recovery. Key Words: Stroke, Rehabilitation, Outcomes Disclosure(s): None Disclosed.