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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(04): 272-277
DOI: 10.1590/0004-282X-anp-2020-0246
Original Article

Translation, cross-cultural adaptation and validation of the Cincinnati prehospital stroke scale in Brazil

Tradução, adaptação transcultural e validação da escala de Cincinnati no Brasil
Priscila Masquetto Vieira de ALMEIDA 
1   Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Campus Botucatu SP, Brazil.
,
Rodrigo BAZAN 
1   Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Campus Botucatu SP, Brazil.
,
Octávio Marques PONTES-NETO 
2   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil.
,
César MINELLI 
3   Hospital Carlos Fernando Malzoni, Departamento de Neurologia, Matão SP, Brazil.
,
José Eduardo CORRENTE 
1   Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Campus Botucatu SP, Brazil.
,
Gabriel Pinheiro MODOLO 
1   Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Campus Botucatu SP, Brazil.
,
Gustavo José LUVIZUTTO 
4   Universidade Federal do Triângulo Mineiro, Uberaba MG, Brazil.
,
Alessandro Lia MONDELLI 
1   Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Campus Botucatu SP, Brazil.
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ABSTRACT

Background: Use of internationally standardized instruments to assist healthcare professionals in accurately recognizing stroke early is recommended. The process of translation and cross-cultural adaptation is important for ensuring that scales are interpreted in the same way in different languages, thus ensuring applicability in several countries. Objective: To translate into Brazilian Portuguese, cross-culturally adapt and validate the Cincinnati Prehospital Stroke Scale, using a representative sample of the Brazilian population. Method: The present study included patients with suspected stroke who were treated at a Brazilian emergency medical service and referred to a stroke center. A systematic process of translation and cross-cultural adaptation of the original scale and application of the final instrument was performed. Statistical analysis was used to assess the sensitivity, specificity and accuracy of the scale. Cohen’s kappa coefficient was used to assess inter-rater reliability. Results: After translation and cross-cultural adaptation, the scale was applied to 64 patients. It showed 93.0% accuracy and 92.4% sensitivity in relation to the final “gold standard” diagnosis. Cohen’s kappa coefficient was calculated using data from 26 patients (40.6%) and showed excellent inter-rater reliability between items on the scale (0.8385 to 1.0000). Conclusion: The scale demonstrated excellent accuracy, sensitivity and inter-rater reliability. It was a useful tool for assisting healthcare professionals during initial assessments on patients with suspected stroke and significantly contributed to early recognition of stroke in a simple and quick manner.

RESUMO

Introdução: O uso de instrumentos padronizados internacionalmente para auxiliar os profissionais de saúde a reconhecer precocemente o AVC é recomendado. O processo de tradução e adaptação transcultural tem sido importante para garantir que a escala seja interpretada da mesma maneira em diferentes idiomas, assegurando sua aplicabilidade em vários países. Objetivo: Traduzir para o idioma português do Brasil, adaptar transculturalmente e validar a Cincinnati Prehospital Stroke Scale na população brasileira. Método: O estudo incluiu pacientes com suspeita de acidente vascular cerebral (AVC) atendidos por um Serviço de Atendimento Móvel Urgência (SAMU) 192 e encaminhados para uma Unidade de Cuidado Integral ao AVC. Foram realizados um processo sistemático de tradução e adaptação transcultural da escala original e a aplicação do instrumento final, que possibilitou a realização dos testes de sensibilidade, especificidade e acurácia, de acordo com o estudo original, além do índice de Cohen de Kappa, para avaliar a confiabilidade interobservador. Resultados: Após a tradução e a adaptação transcultural, a escala foi aplicada em 64 pacientes, apresentando acurácia de 93,0% e sensibilidade de 92,4% em relação ao diagnóstico final, considerado padrão-ouro. Em 26 pacientes (40,6%) foi possível calcular o índice de Cohen de Kappa, evidenciando excelente confiabilidade interobservador entre os itens da escala (0,8385 a 1,0000). Conclusão: A escala apresenta ótima acurácia, sensibilidade e concordância interobservador. Trata-se de um instrumento útil para auxiliar os profissionais da saúde durante a avaliação inicial do paciente com suspeita de AVC, uma vez que contribui significativamente para o reconhecimento precoce da doença de uma maneira simples e rápida.

Keywords:

Stroke - Early Diagnosis - Emergency Medical Service - Sensitivity and Specificity

Palavras-chave:

Acidente Vascular Cerebral - Diagnóstico Precoce - Serviços Médicos de Emergência - Sensibilidade e Especificidade

Authors’ contributions:

PMVA: substantial contributions to the design or development of the study and writing of the article or its critical revision. RB: substantial contributions to the approval of the final version. OMPN: substantial contributions to the collection, analysis and interpretation of data. CM: substantial contributions to the critical revision. JEC: substantial contributions to the collection, analysis and interpretation of data. GPM: substantial contributions to the critical revision. GJL: substantial contributions to the design or development of the study. ALM: substantial contributions to the design or development of the study.




Publikationsverlauf

Eingereicht: 22. Mai 2020

Angenommen: 16. August 2020

Artikel online veröffentlicht:
01. Juni 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stoke Association. Stroke. 2014 Dec;45(12):3754-832. https://www.ahajournals.org/doi/10.1161/STR.20200246202002460046
  • 2 Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart Disease and Stroke Statistics-2018 Update: a report from the American Heart Association. Circulation. 2018 Mar;137(12):e67-e492. https://www.ahajournals.org/doi/full/10.1161/CIR.20200246202002460558
  • 3 Lotufo PA, Goulart AC, Passos VMA, Satake FM, Souza MFM, França EB, et al. Doença cerebrovascular no Brasil de 1990 a 2015: Global Burden of Disease 2015. Rev Bras Epidemiol. 2017 May;20(Suppl. 1):129-41. https://doi.org/10.1590/1980-5497201700050011
  • 4 Brasil. Secretaria de Vigilância em Saúde. Principais causas de morte. Departamento de Análise de Saúde e Vigilância de Doenças Não Transmissíveis. Available from: http://svs.aids.gov.br/dantps/centrais-de-conteudos/paineis-de-monitoramento/mortalidade/gbd-brasil/principais-causas/
  • 5 Guo C, Bai Q, Zhao Z, Zhang J. Recombinant Tissue-Type Plasminogen activator study of wake-up ischemic strokes guided by rapid MRI. Cerebrovasc Dis. 2019 Nov;48(1-2):85-90. https://doi.org/10.1159/000503379
  • 6 Alonso de Leciñana M, Mazya MV., Kostulas N, Del Brutto OH, Abanto C, Massaro AR, et al. Stroke care and application of thrombolysis in Ibero-America. Stroke. 2019 Sep;50(9):2507-12. https://doi.org/10.1161/STROKEAHA.119.025668
  • 7 Fassbender K, Balucani C, Walter S, Levine SR, Haass A, Grotta J. Streamlining of prehospital stroke management: The golden hour. Lancet Neurol. 2013 Jun;12(6):585-96. http://dx.doi.org/10.1016/S1474-4422(13)70100-5
  • 8 Carr K, Yang Y, Roach A, Shivashankar R, Pasquale D, Serulle Y. Mechanical Revascularization in the Era of the Field Assessment Stroke Triage for Emergency Destination (FAST-ED): a retrospective cohort assessment in a community stroke practice. J Stroke Cerebrovasc Dis. 2020 Jan;29(1):104472. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104472
  • 9 Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018 Jan;378(1):11-21. https://doi.org/10.1056/NEJMoa1706442
  • 10 Fladt J, Meier N, Thilemann S, Polymeris A, Traenka C, Seiffge DJ, et al. Reasons for Prehospital Delay in Acute Ischemic Stroke. J Am Heart Assoc. 2019 Oct;8(20):e013101. https://doi.org/10.1161/JAHA.119.013101
  • 11 Rudd M, Buck D, Ford GA, Price CI. A systematic review of stroke recognition instruments in hospital and prehospital settings. Emerg Med J. 2016 Nov;33(11):818-22. https://doi.org/10.1136/emermed-2015-205197
  • 12 Antipova D, Eadie L, Macaden A, Wilson P. Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review. BMC Emerg Med. 2019 Sep;19(1):1-11. https://doi.org/10.1186/s12873-019-0262-1
  • 13 Brandler ES, Sharma M, Sinert RH, Levine SR. Prehospital stroke scales in urban environments: a systematic review. Neurology. 2014 Jun;82(24):2241-9. https://doi.org/10.1212/WNL.20200246202002460523
  • 14 Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati prehospital stroke scale: Reproducibility and validity. Ann Emerg Med. 1999 Apr;33(4):373-8. https://doi.org/10.1016/s0196-0644(99)70299-4
  • 15 Studnek JR, Asimos A, Dodds J, Swanson D. Assessing the validity of the Cincinnati Prehospital Stroke Scale and the Medic Prehospital Assessment for Code Stroke in an urban emergency medical services agency. Prehospital Emerg Care. 2013 Jul;17(3):348-53. https://doi.org/10.3109/10903127.2013.773113
  • 16 Nogueira RG, Silva GS, Lima FO, Yeh YC, Fleming C, Branco D, et al. The FAST-ED App: a smartphone platform for the field triage of patients with stroke. Stroke. 2017 May;48(5):1278-84. https://doi.org/10.1161/STROKEAHA.116.016026
  • 17 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Especializada. Manual Instrutivo da Rede de Atenção às Urgências e Emergências no Sistema Único de Saúde (SUS). Brasília: Editora do Ministério da Saúde; 2013.
  • 18 Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Recommendations for the Cross-Cultural Adaptation of the DASH & QuickDASH Outcome Measures. Inst Work Heal. 2007 Jan;1-45.
  • 19 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar;33(1):159-74. https://doi.org/10.2307/2529310
  • 20 Hosseininezhad M, Sohrabnejad R. Stroke mimics in patients with clinical signs of stroke. Caspian J Intern Med. Summer 2017;8(3):213-6. https://doi.org/10.22088/cjim.8.3.213
  • 21 Reichenheim ME, Moraes CL. Operationalizing the cross-cultural adaptation of epidemological. Rev Saude Publica. 2007 Aug;41(4):1-9. https://doi.org/10.1590/S0034-89102006005000035
  • 22 Thrift AG, Cadilhac DA, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, et al. Global stroke statistics. Int J Stroke. 2014 Jan;9(1):6-18. https://doi.org/10.1111/ijs.12245
  • 23 Luvizutto GJ, Monteiro TA, Braga G, Pontes-Neto OM, de Lima Resende LA, Bazan R. Validation of the Scandinavian Stroke Scale in a Multicultural Population in Brazil. Cerebrovasc Dis Extra. 2012 Jan;2(1):121-6. https://doi.org/10.1159/000345948