Deriving Modified Rankin Scores From Medical Case-Records

Abstract

Background and Purpose— Modified Rankin score (mRS) is traditionally graded using a face-to-face or telephone interview. Certain stroke assessment scales can be derived from a review of a patient’s case-record alone. We hypothesized that mRS could be successfully derived from the narrative within patient case-records. Methods— Sequential patients attending our cerebrovascular outpatient clinic were included. Two independent, blinded clinicians, trained in mRS, assessed case-records to derive mRS. They scored “certainty” of their grading on a 5-point Likert scale. Agreement between derived and traditional face-to-face mRS was calculated using attribute agreement analysis. Results— Fifty patients with a range of disabilities were included. Case-record appraisers were poor at deriving mRS ( k =0.34 against standard). Derived mRS grades showed poor agreement between observers ( k =0.33). There was no relationship between certainty of derived mRS and proportion of correct grades ( P =0.727). Conclusion— Accurate mRS cannot be derived from standard hospital records. Direct mRS interview is still required for clinical trials.