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Background: The National Stroke Project (NSP) was a retrospective cohort study of US Medicare beneficiaries hospitalized with stroke or transient ischemic attack (TIA). The NSP included a simple assessment of stroke severity (NSP-Stroke Scale, NSP-SS). Used for risk adjustment in outcome studies, the reliability and validity of the NSP-SS have not been assessed. We determined the reliability, concurrent and construct validity of the NSP-SS., Methods: The initial neurologic examinations of 100 consecutive patients hospitalized with ischemic stroke/TIA in a single academic medical center were reviewed. The NSP-SS was retrospectively scored twice by the same rater and independently by a second rater to assess reliability. The National Institutes of Health Stroke Scale (NIH-SS) was also scored retrospectively and used as the criterion standard for concurrent validity. Construct validity was based on discharge status., Results: The NSP-SS had moderate-substantial inter-rater (weighted kappa, κ(w) = 0.66, 95% CI 0.55-0.77) and intra-rater (κ(w) = 0.63, 95% CI 0.52-0.75) reliability. Correlation between NSP-SS and NIH-SS scores was moderate (Spearman r = 0.65, 95% CI 0.52-0.75, p < 0.0001) but some categorizations in the NSP-SS seemed inappropriate reflecting poor content validity. Each NSP-SS point was associated with a greater likelihood of poor outcome (OR = 2.1, 95% CI 1.1-3.7, p = 0.016). Based on dichotomized scores (NSP 0-2 and NIH-SS <6; mild deficits), the NSP-SS sensitivity was 70.9% (95% CI 57.9-81.2%), specificity 82.2% (95% CI 68.7-90.7%), likelihood ratio for severe stroke 4.0 (95% CI 2.1-7.6) and likelihood ratio for mild stroke 0.3 (95% CI 0.20-0.5). The dichotomized NSP-SS and NIH-SS similarly predicted poor outcome (NSP-SS >2, OR = 4.7, 95% CI 1.7-13.0, p = 0.003 vs. NIH-SS ≥6, OR = 4.4, 95% CI 1.5-13.0, p = 0.006) with excellent discrimination (C = 0.827 and 0.826, respectively)., Conclusion: The NSP-SS has moderate-substantial reliability but poor content validity and poor to moderate concurrent validity as compared with the NIH-SS. In addition, it is not clear that the NSP-SS is easier to extract from medical records than the NIH-SS. Given this, and its other limitations, the utility of this scale for risk adjustment in future stroke outcome studies is questionable., (Copyright © 2011 S. Karger AG, Basel.)

Background and Purpose- Kidney dysfunction is common among patients hospitalized for ischemic stroke. Understanding the association of kidney disease with poststroke outcomes is important to properly adjust for case mix in outcome studies, payment models and risk-standardized hospital readmission rates. Methods- In this cohort study of fee-for-service Medicare patients admitted with ischemic stroke to 1579 Get With The Guidelines-Stroke participating hospitals between 2009 and 2014, adjusted multivariable Cox proportional hazards models were used to determine the independent associations of estimated glomerular filtration rate (eGFR) and dialysis status with 30-day and 1-year postdischarge mortality and rehospitalizations. Results- Of 204 652 patients discharged alive (median age [25th-75th percentile] 80 years [73.0-86.0], 57.6% women, 79.8% white), 48.8% had an eGFR ≥60, 26.5% an eGFR 45 to 59, 16.3% an eGFR 30 to 44, 5.1% an eGFR 15 to 29, 0.6% an eGFR

Background and purposeKidney disease is a frequent comorbidity in patients presenting with acute ischemic stroke. We evaluated whether the estimated glomerular filtration rate (eGFR) on admission is associated with poststroke in-hospital mortality or discharge disposition.MethodsIn this cohort study, data from ischemic stroke patients in Get With The Guidelines-Stroke linked to fee-for-service Medicare data were analyzed. The Modification of Diet in Renal Disease study equation was used to calculate the eGFR (mL/min/1.73 m2). Dialysis was identified by International Classification of Diseases, Ninth Revision codes. Adjusted multivariable Cox proportional hazards models were used to determine the independent associations of eGFR with discharge disposition and in-hospital mortality. Adjusted individual models also examined whether the association of clinical and demographic factors with outcomes varied by eGFR level.ResultsOf 232 236 patients, 47.3% had an eGFR ≥60, 26.6% an eGFR 45 to 59, 16.8% an eGFR 30 to 44, 5.6% an eGFR 15 to 29, 0.7% an eGFR