Inter–rater reliability of the simplified Modified Rankin Scale as an outcome measure for treated cerebral aneurysm patients - 23/09/22
Abstract |
Background |
The modified Rankin scale (mRS) is commonly used as a clinical outcome measure in aneurysm trials, but inter–observer reliability in treated patients has not been tested.
Methods |
We reviewed the literature on inter–observer reliability studies of the mRS. Sixty patients with ruptured (n=47) or unruptured (n=13) aneurysms treated with endovascular methods (n=34) or surgical clipping (n=26) were independently evaluated by a neurosurgeon, a stroke neurologist, and a novice research assistant, and a simplified mRS score assigned. Results were analyzed using Gwet's AC1/2 reliability coefficients (KG).
Results |
No previous reports validating the reliability of the mRS in treated aneurysm patients were identified. Using the mRS 0–5, inter–rater agreement was almost perfect (KG=0.89 [0.86–0.93]). Agreement between raters remained almost perfect regardless of the rater's expertise. Agreement was almost perfect (KG=0.87 [0.77–0.96] when the mRS was dichotomized 0–2 vs 3–5, but fell to moderate when dichotomized 0–1 vs 2–5 (KG=0.59 (0.42–0.75). Agreement using the 0–2 vs 3–5 dichotomized mRS remained almost perfect for coiled (KG=0.90), clipped (KG=0.82), ruptured (KG=0.84), and unruptured (KG=0.95) aneurysms. Dichotomization of results at 0–1 vs 2–5 would have resulted in an (undesirable) significant difference in good outcomes between raters (P=.003), but not at 0–2 vs 3–5 (P=.52).
Conclusion |
The simplified mRS appears to be a reliable clinical outcome measure for treated cerebral aneurysm patients. When needed, dichotomization is more reliable at mRS 0–2 vs 3–5 than at 0–1 vs 2–5. The simplified mRS is a promising tool in the functional assessment of aneurysm patients recruited in pragmatic care trials.
Le texte complet de cet article est disponible en PDF.Keywords : Cerebral aneurysm, Inter–rater reliability, Simplified modified Rankin scale, Outcome measure, Pragmatic trials
Plan
Vol 68 - N° 5
P. 488-492 - octobre 2022 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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