Measurements of acute cerebral infarction: A clinical examination scale

Thomas Brott, Harold P. Adams, Charles P. Olinger, John R. Marle, William G. Barsan, Jose Biller, Judith Spilker, Renée Holleran, Robert Eberle, Vicki Hertzberg, Marvin Rorick, Charles J. Moomaw, Michael Walker

Research output: Contribution to journalArticlepeer-review

3543 Scopus citations


We designed a 15-item neurologic examination stroke scale for use in acute stroke therapy trials. In a study of 24 stroke patients, interrater reliability for the scale was found to be high (mean k=0.69), and test-retest reliability was also high (mean K=0.66-0.77). Test-retest reliability did not differ significantly among a neurologist, a neurology house officer, a neurology nurse, or an emergency department nurse. The stroke scale validity was assessed by comparing the scale scores obtained prospectively on 65 acute stroke patients to the patients’ infarction size as measured by computed tomography scan at 1 week and to the patients’ clinical outcome as determined at 3 months. These correlations (scale—lesion size r=0.68, scale—outcome r=0.79) suggested acceptable examination and scale validity. Of the 15 test items, the most interrater reliable item (pupillary response) had low validity. Less reliable items such as upper or lower extremity motor function were more valid. We discuss methods for improving the reliability and validity of brief examination scales to be used in stroke therapy trials.

Original languageEnglish (US)
Pages (from-to)864-870
Number of pages7
Issue number7
StatePublished - Jul 1989


  • Cerebral infarction
  • Clinical trials
  • Neurologic examination

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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