Reliability of Scandinavian Neurological Stroke Scale

The Scandinavian hemodilution study in acute ischemic stroke used the neurological scale presented here in assessing prognosis and long-term outcome. The purpose of the present study was to test its interobserver reliability. The scale consists of two parts: one for assessing the acute prognosis and one for assessing the neurological deficit acutely and at follow-up. The items rated are: consciousness, gaze palsy, Iimb weakness, dysphasia, orientation, facial palsy and gait. Fifty acute stroke patients were rated by 2 doctors each. The agreement rates were corrected for chance (kappa statistics). Interobserver agreement was good to excellent with weighted kappa values ranging from 0.688 to 0.912. Patients who died within 6 weeks had a lower prognostic score than the survivors. The long-term scores of 2 observers were highly correlated (R = 0.954). The scale provides a reliable instrument for stratification of stroke patients and for evaluation of long-term outcome.