Reliability of questions about pre-stroke driving, shopping and banking as an alternative to the modified rankin scale for treatment decisions - results from a hospital dataset.

Abstract

Background: Rapid assessment of pre-stroke independence is crucial for reperfusion therapies. Information from family, or third parties is often misleading. Binary questions about activities of driving, shopping, and banking (DSB) can substitute for the mRS but inter-rater reliability is unclear. Method(s): Consecutive suspected stroke patients presenting to the Emergency Department (ED) at Box Hill Hospital (May - December 2023). Clinical data included mRS, reperfusion therapy, and capability for DSB, being alone for 24 hours, or 1 week. DSB activities and being alone was reported at first assessment in ED and 24 hours later in the Stroke ward, by blinded assessors. Spearman's correlation assessed the relationship between first and second assessments. Multivariable logistic regression assessed the association between mRS 0-1/0-2, DSB, and ability to remain alone. Result(s): 135 patients (49% male; mean age 75.5 years, 73% ischaemic stroke). 70% of patients capable of at least one DSB activity, 56% all three DSB activities. Each DSB activity was highly reproducible between the ED and ward assessments (rho: 0.95. 0.95. 0.89), and capacity to be alone for 24 hours (rho=1.00). mRS 0-1 was strongly associated with: 1. each individual DSB activity (ORs: 40, 90, 43), and 2. completing just one of the DSB activities (OR: 61). Age and gender did not alter results. 16/135 (12%) patients were reported as having 24 hour capability to be alone despite no DSB activities. Conclusion(s): Targeted binary questions about DSB and 24 hour capability can reliably identify pre-stroke level of functioning to guide decisions for reperfusion therapies.