Modification to the Miami Emergency Neurological Deficit (MEND) scale to better assess for posterior circulation stroke by nurses

May 2023
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Many posterior circulation stroke symptoms (PCS) are missing from current stroke assessment scales used by nurses to assess patients for strokes in emergency rooms and hospitals across the United States. There is not one stroke assessment tool currently available to assess and weigh anterior and posterior strokes proportionately. The purpose of this study was to modify a current stroke assessment instrument, the Miami Emergency Neurological Deficit (MEND) that can be used by nurses to better assess for PCSs. Specifically, this study examined the reliability and validity of the MEND and modified-MEND used by nurses to assess video presentations of patients with anterior circulation stroke (ACS) and posterior circulation stroke symptoms. A prospective, quantitative methodological study was conducted to test the reliability and validity of the modified-MEND, and the accuracy of the nurses’ ability to recognize ACS and PCS symptoms. The researcher developed patient scenarios of anterior and posterior circulation stroke symptoms. The population consisted of registered nurses from stroke accredited acute care hospitals within the CHRISTUS Health system. A total of 89 registered nurses from 9 stroke-accredited facilities participated in this prospective, quantitative study. Interclass correlation coefficients were used to establish consistency of performance of the MEND and modified-MEND. The ICCs showed excellent reliability of both scales. Pearson correlations were conducted to determine the relationship of the NIHSS, MEND, and modified-MEND for the PCS and ACS patients, showing a strong, positive, statistically significant relationship between the MEND and modified-MEND on both the PCS and ACS patient. A one-way repeated measures ANOVA was analyzed for validity of the modified-MEND, showing statistically significant differences and strong effects sizes for PCS and ACS patient. The Cochran’s Q showed statistically significant differences for the modified-MEND in prediction of stroke versus no stroke compared to the MEND and the NIHSS for the PCS patient, further validating the modified-MEND as a stroke assessment tool. There were no statistically significant differences between nursing demographics and accuracy and predication of stroke for the PCS or ACS patient. Results of this study adds new information to the body of evidence regarding stroke assessment scales. Findings from this study support an acceptable level of validity and reliability of the modified-MEND as a stroke assessment tool. Based on what is available in the literature, the modified-MEND may be the first reliable and valid stroke assessment scale that assesses for both PCS and ACS adequately, leaving no reason for missed identification and treatment of PCS patients.

Health Sciences, Nursing