FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1994243644> ?p ?o ?g. }

• W1994243644 abstract "HomeStrokeVol. 45, No. 3Reliability and Validity of the National Institutes of Health Stroke Scale for Neuroscience Nurses Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBReliability and Validity of the National Institutes of Health Stroke Scale for Neuroscience Nurses Janice L. Hinkle, RN, PhD, CNRN, FAHA Janice L. HinkleJanice L. Hinkle From the Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, Bethesda, MD. Search for more papers by this author Originally published4 Feb 2014https://doi.org/10.1161/STROKEAHA.113.004243Stroke. 2014;45:e32–e34Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2014: Previous Version 1 IntroductionThe National Institutes of Health Stroke Scale (NIHSS) is used widely among stroke neurologists and neuroscience nurses. It is most commonly used with acute ischemic stroke (AIS) but is also used to assess patients after hemorrhagic stroke or a suspected transient ischemic attack. The scale is used widely to assess patient status acutely, to assess treatment efficacy, and to predict outcome. This article provides a review of pertinent information about the reliability, validity, instruction, and competency on the scale for neuroscience nurses.The NIHSS was introduced as a 15-item scale, later reduced to 14 items developed by stroke neurologists from the University of Cincinnati, the University of Iowa and the National Institutes of Health-National Institute of Neurological Disorders and Stroke.1,2 This graded physical examination is a measure of impairment that assesses level of consciousness using 3 items, speech, language, cognition, inattention, visual field abnormalities, motor strength (4 items), sensory impairment, and ataxia. It was designed specifically for AIS clinical trials, and potential scores range from 0 to 42. A modified version that removed the initial level of consciousness item, as well as the ataxia, facial weakness, and dysarthria items resulted in an 11-item scale with potential scores ranging from 0 to 31.3Training and certification in use of the NIHSS are recommended.4 Formal training can be found in ≥2 places (www.strokeassociation.com or www.ninds.gov). Since the success of the National Institute of Neurological Disorders and Stroke intravenous recombinant tissue plasminogen activator (rt-PA) trial, it has been acknowledged that performing and documenting a physical examination in the most efficient and useful manner is a key element of nursing care for the patient with AIS.5 The most efficient manner for assessing patients who are awake is to use the NIHSS. In AIS it is advisable for the neurologist and nurse to perform the initial assessment together.2 Nurses should perform a complete bedside NIHSS assessment on admission to the intensive care unit and then an abbreviated version can be performed for the more frequent assessments needed for the patient who is post treatment with intravenous rt-PA.4 A complete NIHSS should be done if there is evidence of neurological decline or if there is an increase in the abbreviated score.ReliabilityA measurement instrument that is reliable is one that is dependable, stable, consistent, predictable, and accurate across time. In statistical terms reliability is the ability of an instrument to measure something consistently and repeatedly in the same manner. It is easiest to picture reliability when thinking about physical measures such as weight. For example, when measuring weight, given that all other variables are the same (like how much food was consumed) if a scale weighs a person at a 120 pounds today, then that same scale should weigh that person at 120 pounds the next day. Understanding reliability in an observational scale for something like a physical examination is not quite as straightforward.An important aspect of reliability of the NIHSS is the ability of the measure to produce the same results when used by different individuals. This is called inter-rater or interobserver reliability sometimes reported using an intraclass correlation coefficient. The κ statistic or κ coefficient is also used commonly to indicate the magnitude of agreement between observers. A κ of 1 indicates complete agreement, whereas a κ of 0 indicates that the agreement is because of chance. A κ can be reported as weighted or unweighted.6An important aspect of inter-rater reliability is agreement on total scores. The overall reliability of the NIHSS in the context of stroke clinical trials is well established.7 One study assessed the reliability of the NIHSS when administered by research nurses.8 Using the NIHSS, 31 consecutive patients who had a stroke were assessed by 2 neurologists and 1 of 2 trained research nurses. There was a high level of agreement for total scores between the 2 neurologists (intraclass correlation coefficient=0.95) and between each neurologist and research nurse (intraclass correlation coefficient=0.92 and 0.96). It was concluded that in both hospital and community settings, trained research nurses can administer the NIHSS with reliability similar to stroke-trained neurologists.8Another study investigated the reliability of the NIHSS in a representative sample of raters who had completed videotaped certification examinations on the National Stroke association website between 1998 and 2004. There were 7405 unique raters and more than half (54%) of them were registered nurses.9 Nurses agreed with the most common response on scoring more frequently than physicians (P<0.0001) and 91% if the registered nurses passed the certification examination.9An additional aspect of inter-rater reliability is agreement on individual item scores within the scale. One study reported moderate to excellent agreement (weighted κ>4) overall between neurologists and research nurses on the majority of the NIHSS items but poor agreement on the limb ataxia item.8 In another study, a total of 38 148 individual NIHSS item responses reported poor agreement on 4 items.9 In a large sample of clinicians, the agreement on the limb ataxia item was extremely low, whereas the 3 items assessing gaze, aphasia, and facial weakness were low using an unweighted κ statistic.9 Another study using updated cases reported low agreement on the ataxia and facial weakness items.10ValidityValidity in behavioral measures refers to how well the instrument actually measures the construct it says it is measuring.11 For example, if an instrument is measuring disability, is it really measuring disability or it is measuring impairment? The validity of the NIHSS has been studied in several different ways.The clinical predictive validity of the NIHSS is useful to neuroscience nurses in many ways. There have been a variety of studies in the acute phase of stroke. In a study of 643 patients with AIS, an initial total NIHSS score of ≥8 points was predictive of neurological deteriorations within the first week.12 In the National Institute of Neurological Disorders and Stroke intravenous rt-PA trial patients with an NIHSS, total score of >22 had a 17% risk of intracranial hemorrhage, whereas patients with a total NIHSS score of <10 had a 3% risk.4 A total NIHSS >25 is an exclusion criterion for rt-PA.13One small study looked at the NIHSS items and found that increases in the loss of consciousness and motor limbs total scores were related to neurological deterioration within the first 120 minutes after administration of intravenous rt-PA.14 Another study reported that an improvement in the total NHISS of >3 points at 15 minutes or of >5 points at 30 minutes predicts a more favorable outcome and helps identify patients who are not responding to rt-PA.15 A Swedish study of 347 patients found that for each point on the baseline NIHSS there was an increase in length of stay by 0.8 days and the total length of stay (including rehabilitation) by 3.4 days up to a NIHSS of 19 points.16 The NIHSS was better at predicting the presence of dysphagia compared with a nursing dysphagia screening tool in a retrospective cohort study of veterans admitted with ischemic stroke.17Several studies have looked at outcome after hospitalization. In a study of 385 patients 3 months after a stroke, a total NIHSS score of ≥15 points was associated strongly with the patient being dependent (in a nursing home, chronic home, or substantially dependent on a caregiver).18 One study reported that patients with a NIHSS total score of <10 have a more favorable outcome at 1 year compared with patients with an NIHSS score of >20.19 In a community-based sample of 377 patients scoring <4 on baseline NIHSS, 75% were independent 1 year after the stroke, 17% were dependent, and 8% were dead.20 Predicting outcome makes the NIHSS useful for neuroscience nurses working with families on discharge planning needs.4,21,22Factor analysis is a statistical process that is used to establish how individual items cluster around a dimension. Two factors were found in factor analysis of the NIHSS corresponding to left and right brain function in a sample of mild to moderate stroke23 and another of patients with large strokes.24 In both studies patients with left brain strokes score 4 points higher on the NIHSS compared with right brain strokes.23,24Learning the NIHSSThe NIHSS has been taught in person, with videotapes, DVDs and is now there are professionally filmed cases for training and testing are on the Web. Instruction takes 2 to 3 hours. Still the best method of learning the scale is debated. One study compared the use of videotaped instruction to an interactive computer-assisted instruction to teach the Chinese version of the NIHSS.25 The nurses with less experience in neurological nursing performed a better assessment after the interactive computer-assisted instruction compared with nurses who were taught with an instructor-led program using the videotape.25 More research is needed to determine the best method of instruction for the NIHSS.CompetencyJust because an individual has been educated about the use of a scale and even received a certificate does not indicate they are competent in the performance of the scale. This is particularly true in instances when the scale is not used on a day-to-day basis. A self-assessment of competency of neurological assessment techniques that follows the components of the NIHSS using a clinical skills checklist has been developed.26 Clearly more work is needed in the area of competency for the NIHSS.Take-Home PointsThe NIHSS has a high degree of both reliability and validity when used by neuroscience nurses.The scale is useful in identifying patients at highest risk for intracranial hemorrhage and those not responding to rt-PA.Research is needed to determine the best method of instruction for the NIHSS.Further work is needed in the area of competency for neuroscience nurses using the NIHSS.DisclosuresNone.FootnotesThe opinions expressed in this review are those of the author and do not necessarily reflect National Institute of Neurological Disease and Stroke policies.Correspondence to Janice L. Hinkle, PhD, Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, 10 Center Dr, Bldg 10, Room B1D-733, MSC 1063, Bethesda, MD 20892-1063. E-mail [email protected] or [email protected]References1. Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale.Stroke. 1989; 20:864–870.LinkGoogle Scholar2. Brott T, Reed RL. Intensive care for acute stroke in the community hospital setting. The first 24 hours.Stroke. 1989; 20:694–697.LinkGoogle Scholar3. Meyer BC, Hemmen TM, Jackson CM, Lyden PD. Modified National Institutes of Health Stroke Scale for use in stroke clinical trials: prospective reliability and validity.Stroke. 2002; 33:1261–1266.LinkGoogle Scholar4. Summers D, Leonard A, Wentworth D, Saver JL, Simpson J, Spilker JA, et al; American Heart Association Council on Cardiovascular Nursing and the Stroke Council. Comprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient: a scientific statement from the American Heart Association.Stroke. 2009; 40:2911–2944.LinkGoogle Scholar5. Spilker J, Kongable G, Barch C, Braimah J, Brattina P, Daley S, et al. Using the NIH Stroke Scale to assess stroke patients. The NINDS rt-PA Stroke Study Group.J Neurosci Nurs. 1997; 29:384–392.CrossrefMedlineGoogle Scholar6. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic.Fam Med. 2005; 37:360–363.MedlineGoogle Scholar7. Goldstein LB, Samsa GP. Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial.Stroke. 1997; 28:307–310.LinkGoogle Scholar8. Dewey HM, Donnan GA, Freeman EJ, Sharples CM, Macdonell RA, McNeil JJ, et al. Interrater reliability of the National Institutes of Health Stroke Scale: rating by neurologists and nurses in a community-based stroke incidence study.Cerebrovasc Dis. 1999; 9:323–327.CrossrefMedlineGoogle Scholar9. Josephson SA, Hills NK, Johnston SC. NIH Stroke Scale reliability in ratings from a large sample of clinicians.Cerebrovasc Dis. 2006; 22:389–395.CrossrefMedlineGoogle Scholar10. Lyden P, Raman R, Liu L, Grotta J, Broderick J, Olson S, et al. NIHSS training and certification using a new digital video disk is reliable.Stroke. 2005; 36:2446–2449.LinkGoogle Scholar11. Kerlinger FFoundations of Behavioural Research. Orlando: Harcourt Brace Jovanovich; 1986.Google Scholar12. Miyamoto N, Tanaka Y, Ueno Y, Kawamura M, Shimada Y, Tanaka R, et al. Demographic, clinical, and radiologic predictors of neurologic deterioration in patients with acute ischemic stroke.J Stroke Cerebrovasc Dis. 2013; 22:205–210.CrossrefMedlineGoogle Scholar13. Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, et al; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013; 44:870–947.LinkGoogle Scholar14. Nanri Y, Yakushiji Y, Hara M, Eriguchi M, Okada R, Yukitake M, et al. Stroke scale items associated with neurologic deterioration within 24 hours after recombinant tissue plasminogen activator therapy.J Stroke Cerebrovasc Dis. 2013; 22:1117–1124.CrossrefMedlineGoogle Scholar15. Takagi T, Kato T, Sakai H, Nishimura Y. Early Neurologic Improvement Based on the National Institutes of Health Stroke Scale Score Predicts Favorable Outcome within 30 Minutes after Undergoing Intravenous Recombinant Tissue Plasminogen Activator Therapy.J Stroke Cerebrovasc Dis. 2014; 23:69–74.CrossrefMedlineGoogle Scholar16. Appelros P. Prediction of length of stay for stroke patients.Acta Neurol Scand. 2007; 116:15–19.CrossrefMedlineGoogle Scholar17. Bravata DM, Daggett VS, Woodward-Hagg H, Damush T, Plue L, Russell S, et al. Comparison of two approaches to screen for dysphagia among acute ischemic stroke patients: nursing admission screening tool versus National Institutes of Health stroke scale.J Rehabil Res Dev. 2009; 46:1127–1134.CrossrefMedlineGoogle Scholar18. Johnston KC, Wagner DP. Relationship between 3-month National Institutes of Health Stroke Scale score and dependence in ischemic stroke patients.Neuroepidemiology. 2006; 27:96–100.CrossrefMedlineGoogle Scholar19. Kwiatkowski TG, Libman RB, Frankel M, Tilley BC, Morgenstern LB, Lu M, et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group.N Engl J Med. 1999; 340:1781–1787.CrossrefMedlineGoogle Scholar20. Appelros P, Terént A. Characteristics of the National Institute of Health Stroke Scale: results from a population-based stroke cohort at baseline and after one year.Cerebrovasc Dis. 2004; 17:21–27.CrossrefMedlineGoogle Scholar21. Schlegel D, Kolb SJ, Luciano JM, Tovar JM, Cucchiara BL, Liebeskind DS, et al. Utility of the NIH Stroke Scale as a predictor of hospital disposition.Stroke. 2003; 34:134–137.LinkGoogle Scholar22. Schlegel DJ, Tanne D, Demchuk AM, Levine SR, Kasner SE; Multicenter rt-PA Stroke Survey Group. Prediction of hospital disposition after thrombolysis for acute ischemic stroke using the National Institutes of Health Stroke Scale.Arch Neurol. 2004; 61:1061–1064.CrossrefMedlineGoogle Scholar23. Lyden P, Lu M, Jackson C, Marler J, Kothari R, Brott T, et al. Underlying structure of the national institutes of health stroke scale - results of a factor analysis.Stroke. 1999; 30:2347–2354.LinkGoogle Scholar24. Lyden P, Claesson L, Havstad S, Ashwood T, Lu M. Factor analysis of the National Institutes of Health Stroke Scale in patients with large strokes.Arch Neurol. 2004; 61:1677–1680.CrossrefMedlineGoogle Scholar25. Chiu SC, Cheng KY, Sun TK, Chang KC, Tan TY, Lin TK, et al. The effectiveness of interactive computer assisted instruction compared to videotaped instruction for teaching nurses to assess neurological function of stroke patients: a randomized controlled trial.Int J Nurs Stud. 2009; 46:1548–1556.CrossrefMedlineGoogle Scholar26. Gocan S, Fisher A. Neurological assessment by nurses using the National Institutes of Health Stroke Scale: implementation of best practice guidelines.Can J Neurosci Nurs. 2008; 30:31–42.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By de Graaf J, Volkers E, Schepers V, Visser-Meily J and Post M (2021) Validity of the Utrecht scale for evaluation of rehabilitation-participation restrictions scale in a hospital-based stroke population 3 months after stroke, Topics in Stroke Rehabilitation, 10.1080/10749357.2021.1956047, (1-10) DE GRAAF J, VISSER-MEILY J, SCHEPERS V, BAARS A, KAPPELLE L, PASSIER P, WERMER M, DE WIT D and POST M Comparison between EQ-5D-5L and PROMIS-10 to evaluate health-related quality of life 3 months after stroke: a cross-sectional multicenter study, European Journal of Physical and Rehabilitation Medicine, 10.23736/S1973-9087.21.06335-8, 57:3 Green T, McNair N, Hinkle J, Middleton S, Miller E, Perrin S, Power M, Southerland A and Summers D (2021) Care of the Patient With Acute Ischemic Stroke (Posthyperacute and Prehospital Discharge): Update to 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association, Stroke, 52:5, (e179-e197), Online publication date: 1-May-2021. Wu X, Duan Z, Liu Y, Zhou C, Jiao Z, Zhao Y and Tang T (2021) Incidental Unruptured Intracranial Aneurysms Do Not Impact Outcome in Patients With Acute Cerebral Infarction, Frontiers in Neurology, 10.3389/fneur.2021.613027, 12 Tessua K, Munseri P, Matuja S and Barboza M (2021) Outcomes within a year following first ever stroke in Tanzania, PLOS ONE, 10.1371/journal.pone.0246492, 16:2, (e0246492) Rouzbahani A, Khodadadi E and Fooladi M (2020) Impact of Mild Hypothermia on Final Outcome of Patients with Acute Stroke: A Randomized Clinical Trial, Indian Journal of Neurotrauma, 10.1055/s-0040-1713462, 17:01, (17-23), Online publication date: 1-Jun-2020. de Graaf J, Kuijpers M, Visser-Meily J, Kappelle L and Post M (2020) Validity of an enhanced EQ-5D-5L measure with an added cognitive dimension in patients with stroke, Clinical Rehabilitation, 10.1177/0269215520907990, 34:4, (545-550), Online publication date: 1-Apr-2020. Wells-Pittman J and Gullicksrud A (2020) Standardizing the Frequency of Neurologic Assessment After Acute Stroke, AJN, American Journal of Nursing, 10.1097/01.NAJ.0000656348.54457.60, 120:3, (48-54), Online publication date: 1-Mar-2020. Eskildsen S, Jakobsen D, Riberholt C, Poulsen I and Curtis D (2019) Protocol for a scoping review study to identify and map treatments for dysphagia following moderate to severe acquired brain injury, BMJ Open, 10.1136/bmjopen-2019-029061, 9:7, (e029061), Online publication date: 1-Jul-2019. Rozbahani A, Rezaee M and Khazaei M (2019) Impact of Mild Hypothermia on the Recovery of Patients with Acute Stroke, Avicenna Journal of Clinical Medicine, 10.29252/ajcm.26.1.26, 26:1, (26-33), Online publication date: 1-Jun-2019. Juhasz Z and Issa M (2019) EEG Based Imaging of Stroke Location, Extent and Progress of Recovery Using a GPU Architecture 2019 42nd International Convention on Information and Communication Technology, Electronics and Microelectronics (MIPRO), 10.23919/MIPRO.2019.8757035, 978-953-233-098-4, (369-374) Farooq M, Goshgarian C, Gould B, Groenhout A and Gorelick P (2019) Stroke Reference Module in Biomedical Sciences, 10.1016/B978-0-12-801238-3.11277-2, . Song J, Lee M and Jung D (2017) The Effects of Delirium Prevention Guidelines on Elderly Stroke Patients, Clinical Nursing Research, 10.1177/1054773817721400, 27:8, (967-983), Online publication date: 1-Nov-2018. Pai H, Lai M, Chen A and Lin P (2018) Change in Activities of Daily Living in the Year Following a Stroke, Nursing Research, 10.1097/NNR.0000000000000280, 67:4, (286-293), Online publication date: 1-Jul-2018. Klinke M, Hjaltason H, Tryggvadóttir G and Jónsdóttir H (2017) Hemispatial neglect following right hemisphere stroke: clinical course and sensitivity of diagnostic tasks, Topics in Stroke Rehabilitation, 10.1080/10749357.2017.1394632, 25:2, (120-130), Online publication date: 17-Feb-2018. Hunter S, Johansen-Berg H, Ward N, Kennedy N, Chandler E, Weir C, Rothwell J, Wing A, Grey M, Barton G, Leavey N, Havis C, Lemon R, Burridge J, Dymond A and Pomeroy V (2018) Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial, Frontiers in Neurology, 10.3389/fneur.2017.00733, 8 Pei C, Yong Z, Lili L, Xing C, Yi R, Lan J, Shuang W, Wenting W, Yuguang W and Yihuai Z (2017) Efficacy and safety of Xinglouchengqi decoction for acute ischemic stroke with constipation: study protocol for a randomized controlled trial, Journal of Traditional Chinese Medicine, 10.1016/S0254-6272(18)30045-1, 37:6, (810-818), Online publication date: 1-Dec-2017. Raza S, Frankel M and Rangaraju S (2017) Abbreviation of the Follow-Up NIH Stroke Scale Using Factor Analysis, Cerebrovascular Diseases Extra, 10.1159/000479933, 7:3, (120-129) Dancer S, Brown A and Yanase L (2017) National Institutes of Health Stroke Scale in Plain English Is Reliable for Novice Nurse Users with Minimal Training, Journal of Emergency Nursing, 10.1016/j.jen.2016.09.002, 43:3, (221-227), Online publication date: 1-May-2017. Klinke M, Hjaltason H, Hafsteinsdóttir T and Jónsdóttir H (2016) Spatial neglect in stroke patients after discharge from rehabilitation to own home: a mixed method study, Disability and Rehabilitation, 10.3109/09638288.2015.1130176, 38:25, (2429-2444), Online publication date: 3-Dec-2016. Hu X, Bai X, Zai N, Sun X, Zhu L and Li X (2016) Prognostic value of perfusion-weighted magnetic resonance imaging in acute intracerebral hemorrhage, Neurological Research, 10.1080/01616412.2016.1177932, 38:7, (614-619), Online publication date: 2-Jul-2016. Middleton S, Grimley R and Alexandrov A (2015) Triage, Treatment, and Transfer, Stroke, 46:2, (e18-e25), Online publication date: 1-Feb-2015. Yang X, An H and Zhang J (2014) Neuropeptide proenkephalin A is associated with in-hospital mortality in patients with acute intracerebral hemorrhage, Peptides, 10.1016/j.peptides.2014.06.005, 58, (47-51), Online publication date: 1-Aug-2014. March 2014Vol 45, Issue 3 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.113.004243PMID: 24496393 Manuscript receivedDecember 23, 2013Manuscript acceptedJanuary 3, 2014Originally publishedFebruary 4, 2014 Keywordsreliability and validityPDF download Advertisement SubjectsCerebrovascular Disease/StrokeIschemic StrokeNursing" @default.
• W1994243644 created "2016-06-24" @default.
• W1994243644 creator A5073385112 @default.
• W1994243644 date "2014-03-01" @default.
• W1994243644 modified "2023-10-03" @default.
• W1994243644 title "Reliability and Validity of the National Institutes of Health Stroke Scale for Neuroscience Nurses" @default.
• W1994243644 cites W1965968585 @default.
• W1994243644 cites W1969980996 @default.
• W1994243644 cites W1979599429 @default.
• W1994243644 cites W1989725665 @default.
• W1994243644 cites W1996422166 @default.
• W1994243644 cites W2011569768 @default.
• W1994243644 cites W2013597704 @default.
• W1994243644 cites W2068138441 @default.
• W1994243644 cites W2078368507 @default.
• W1994243644 cites W2078666813 @default.
• W1994243644 cites W2079841454 @default.
• W1994243644 cites W2080504768 @default.
• W1994243644 cites W2082093356 @default.
• W1994243644 cites W2088729244 @default.
• W1994243644 cites W2129409167 @default.
• W1994243644 cites W2139767844 @default.
• W1994243644 cites W2171165037 @default.
• W1994243644 cites W2197429867 @default.
• W1994243644 cites W2341972145 @default.
• W1994243644 cites W4234562704 @default.
• W1994243644 doi "https://doi.org/10.1161/strokeaha.113.004243" @default.
• W1994243644 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/24496393" @default.
• W1994243644 hasPublicationYear "2014" @default.
• W1994243644 type Work @default.
• W1994243644 sameAs 1994243644 @default.
• W1994243644 citedByCount "33" @default.
• W1994243644 countsByYear W19942436442014 @default.
• W1994243644 countsByYear W19942436442015 @default.
• W1994243644 countsByYear W19942436442016 @default.
• W1994243644 countsByYear W19942436442017 @default.
• W1994243644 countsByYear W19942436442018 @default.
• W1994243644 countsByYear W19942436442019 @default.
• W1994243644 countsByYear W19942436442020 @default.
• W1994243644 countsByYear W19942436442021 @default.
• W1994243644 countsByYear W19942436442022 @default.
• W1994243644 countsByYear W19942436442023 @default.
• W1994243644 crossrefType "journal-article" @default.
• W1994243644 hasAuthorship W1994243644A5073385112 @default.
• W1994243644 hasBestOaLocation W19942436441 @default.
• W1994243644 hasConcept C118552586 @default.
• W1994243644 hasConcept C121332964 @default.
• W1994243644 hasConcept C127413603 @default.
• W1994243644 hasConcept C15744967 @default.
• W1994243644 hasConcept C163258240 @default.
• W1994243644 hasConcept C169760540 @default.
• W1994243644 hasConcept C171606756 @default.
• W1994243644 hasConcept C2778755073 @default.
• W1994243644 hasConcept C2780645631 @default.
• W1994243644 hasConcept C43214815 @default.
• W1994243644 hasConcept C62520636 @default.
• W1994243644 hasConcept C70364389 @default.
• W1994243644 hasConcept C70410870 @default.
• W1994243644 hasConcept C71924100 @default.
• W1994243644 hasConcept C78519656 @default.
• W1994243644 hasConcept C99508421 @default.
• W1994243644 hasConceptScore W1994243644C118552586 @default.
• W1994243644 hasConceptScore W1994243644C121332964 @default.
• W1994243644 hasConceptScore W1994243644C127413603 @default.
• W1994243644 hasConceptScore W1994243644C15744967 @default.
• W1994243644 hasConceptScore W1994243644C163258240 @default.
• W1994243644 hasConceptScore W1994243644C169760540 @default.
• W1994243644 hasConceptScore W1994243644C171606756 @default.
• W1994243644 hasConceptScore W1994243644C2778755073 @default.
• W1994243644 hasConceptScore W1994243644C2780645631 @default.
• W1994243644 hasConceptScore W1994243644C43214815 @default.
• W1994243644 hasConceptScore W1994243644C62520636 @default.
• W1994243644 hasConceptScore W1994243644C70364389 @default.
• W1994243644 hasConceptScore W1994243644C70410870 @default.
• W1994243644 hasConceptScore W1994243644C71924100 @default.
• W1994243644 hasConceptScore W1994243644C78519656 @default.
• W1994243644 hasConceptScore W1994243644C99508421 @default.
• W1994243644 hasIssue "3" @default.
• W1994243644 hasLocation W19942436441 @default.
• W1994243644 hasLocation W19942436442 @default.
• W1994243644 hasOpenAccess W1994243644 @default.
• W1994243644 hasPrimaryLocation W19942436441 @default.
• W1994243644 hasRelatedWork W150138952 @default.
• W1994243644 hasRelatedWork W1514722593 @default.
• W1994243644 hasRelatedWork W1576292940 @default.
• W1994243644 hasRelatedWork W2026892752 @default.
• W1994243644 hasRelatedWork W2072633245 @default.
• W1994243644 hasRelatedWork W2144793026 @default.
• W1994243644 hasRelatedWork W2352860193 @default.
• W1994243644 hasRelatedWork W2891451466 @default.
• W1994243644 hasRelatedWork W3161482170 @default.
• W1994243644 hasRelatedWork W3190979851 @default.
• W1994243644 hasVolume "45" @default.
• W1994243644 isParatext "false" @default.
• W1994243644 isRetracted "false" @default.
• W1994243644 magId "1994243644" @default.
• W1994243644 workType "article" @default.