Comparison of Bedside and Remote Assessments on the NIHSS Scale in Patients in the Acute Period of Stroke

Objectives – remote assessments on the NIHSS conducted by neurologists using high-quality video conferencing (VC) is recommended when bedside assessment by such a specialist is not available. This recommendation is based on a small number of studies which are not free of systematic errors associated with the subjectivity of the NIHSS. The aim of this study was to minimize these errors. Materials and methods. Six experienced neurologists took part in the study and worked in 15 pairs, along with 90 patients with stable poststroke status no more than 48 h after symptom onset. Each pair of doctors assessed six patients. Each patient was independently evaluated once at the bedside and once remotely. During remote assessment using high-quality VC, the neurologist was assisted by a nurse at the patient's bedside. The distribution of patients by pairs of doctors and sequences of bedside and remote assessments were randomized by block randomization. The comparability of the assessments was evaluated using the κ coefficient and in terms of the proportion of patients for which difference between total NIHSS scores were no more than three points. Results. Differences in NIHSS assessments of no more than three points were obtained in 85.6% (95% CI 76.6–92.1%) of patients. Thus, in practice, remote assessments were clinically significantly different from bedside assessments in one in five patients. Quadratically weighted κ values for total scale scores were 0.91 (95% CI 0.87–0.95). The least concordant subscales were: following commands (ϰ = 0.46), facial muscle paresis (ϰ = 0.43), and limb ataxia (ϰ = 0.27). Remote assessments took longer than bedside assessments: 8 [7, 9] min compared with 6 [5, 8] min (p < 0.001). Conclusions. Remote NIHSS assessments of stroke patients using high-quality VC were comparable with bedside assessments, though further evaluation is required to determine suitability for clinical practice.

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