Abstract NS9: Screening for Spatial Neglect in a Ward-based Environment Within Two Weeks From Stroke Onset: Preliminary Results of a Pilot Study

Abstract

Background and purpose: Spatial neglect (SN) occurs frequently in patients with stroke, resulting in worse recovery. Without screening, the presence of SN may remain undetected and prevent initiation of alleviating strategies. There is limited evidence available to suggest bedside identification of SN in the subacute phase following stroke. Thus we set out to identify effective screening tests for SN. Method: The following index tests were used; (a) six conventional subtests of The Behavioural Inattention test (BIT), (b) an additional figure copying test, (c) a newly developed neglect experience questionnaire, and (d) an additional component added to the National Institute of Health Stroke Scale (NIHSS). The Catherine Bergego Scale (CBS) functioned as a reference frame to ascertain the presence of SN. Results: Consecutive stroke patients (N=125) were included from the Neurological Department of Landspitali University Hospital in Iceland, within two weeks following stroke. Of those 30 patients had SN. If all subtests of the BIT were administered, approximately 35% of stroke patients without SN would be incorrectly identified with the disorder. Statistically more patients without SN were identified as having SN if ≥ three tests of the BIT was administered (p=0.002). If patients did not, at stroke onset, comprehend why they had to go to the hospital, this was correlated to the presence of SN. The star cancellation and figure copying were the most sensitive paper-and pen tests to identify SN. Inclusion of an additional item to NIHSS correctly identified SN in 86% instances. Conclusion: Results contests the common belief that use of more tests increase identification of SN. Rather we found that the use a large test battery decreases sensitivity in the subacute phase following stroke. A short question about patients’ experiences of stroke onset and adding a novel item to the NIHSS provided new pragmatic ways of identifying SN. Results have been used to inform a larger cross-country study between Iceland and Lithuania, where psychometric properties of screening strategies are being further validated.