What question did this study set out to answer?

This study aims to validate the Swansea Stroke Scale (SSS) for use by non-specialist staff in acute stroke settings.

May 8, 2026Open Access

Abstract Number: Esoc2026a1115 Swansea Stroke Scale- A Validated Clinical Scale for Use by Multi-Disciplinary Staff in Acute Stroke

Puntos clave

This study aims to validate the Swansea Stroke Scale (SSS) for use by non-specialist staff in acute stroke settings.
Recruited 135 stroke survivors with symptom onset <7 days in an acute stroke unit.
Evaluated convergent validity by comparing SSS with NIHSS on Day 1; assessed inter-rater agreement on Day 2.
Used preadmission modified Rankin score (mRS) for divergent validity and 30-day outcomes for predictive validity.
Strong convergent validity with Pearson’s Correlation 0.924 (p<0.001, 95% CI 0.895-0.945) between SSS and NIHSS.
Low correlation with pre-admission mRS, confirming divergent validity (r=0.18, p=0.037).
Excellent inter-rater agreement shown by intraclass correlation of 0.99 (p<0.001, 95% CI 0.987-0.993).

Resumen

Abstract Background and aims In the United Kingdom, there is shortage of Stroke specialists. Multi-disciplinary teams (health care support workers, physician associates, resident doctors and stroke nurses) increasingly deliver post-stroke care. Neurological decline in acute phase could be missed due to lack of simple neurological examination. We developed the Swansea Stroke Scale (SSS), a tool similar to the Glasgow Coma Scale, but specific to stroke for this staff cohort. The SSS evaluates 5 constructs- Situation, Sight, Speech, Oral intake and Movement. Scores range from 5 (no deficits) to 20 (maximal deficits). This study validates the SSS against the specialist-led National Institute of Health Stroke Scale (NIHSS). Methods Approved by the Research Ethics committee, study recruited 135 stroke survivors, over 18 years, in acute stroke unit with symptom onset 7 days. Convergent validity evaluated with paired assessments of SSS and NIHSS on Day 1; preadmission modified Rankin score (mRS) used for divergent validity. Two non-specialists on Day 2 evaluated inter-rater agreement via independent SSS assessments. 30 days outcome used for predictive validity. Results Pearson’s Correlation 0.924 (p0.001, 95% CI 0.895-0.945) between SSS and NIHSS indicates strong convergent validity. Divergent validity was confirmed by low correlation with pre-admission mRS (r=0.18, p=0.037). Intraclass correlation of 0.99 (p0.001, 95% CI 0.987-0.993) between two assessors showed excellent inter-rater agreement. SSS is statistically significant (F 18.71, p0.001) for 30 day disposition. Conclusions The new stroke scale for non-specialists revealed strong validity and reliability against NIHSS by specialists, has good 30-day outcome prediction with wider implications in areas deficient of stroke specialists. Conflict of interest M Krishnan: nothing to disclose. W Y Cheung: nothing to disclose. S Storton: nothing to disclose. S Winsor: nothing to disclose. R Rai: nothing to disclose. G Edwards: nothing to disclose. E Evans: nothing to disclose. H Breeze-Jones: nothing to disclose. S C Bain: nothing to disclose. R A Thomas: nothing to disclose

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