The Quick Neurologic Examination Tool in the PICU: Apirada Thongsing, MD

WATCH TIME: 3 minutes

“We focused on 4 domains: mental status, communication, motor function, and cranial nerves (or brainstem reflex). Those were the main things we wanted to focus on, rather than doing a full neuro exam, so it would be easier for us to talk to each other.”

An assessment of a novel and standardized quick neurologic examination (QNE) tool has demonstrated validity for use in neurological examinations of patients in the pediatric intensive care unit (PICU).¹

Presented at the 2022 American Academy of Neurology (AAN) Annual Meeting, April 2-7, in Seattle, Washington, by Apirada Thongsing, MD, resident physician, Department of Neurology, Montefiore Medical Center, and colleagues, the QNE displayed good interrater reliability, agreement, and validity in a 23-participant cohort assessed with varying combinations of raters, including resident and attending physicians, and nurses.

The tool includes an evaluation of 4 neurologic domains: the level of consciousness, communication ability, motor function, and cranial nerves. Each domain is scored from 0 to 4, with 0 being worst and 4 being best. As such, total scores range from 0 to 16. The patients in the PICU who were included were aged 2-21 years with a neurologic diagnosis. Validity was determined by comparison of categories between neurologists and nonspecialists, with the comparison between QNE and Glasgow Coma Scale (GCS) or Full Outline of Un-Responsiveness (FOUR) scores conducted with simple linear regression.

Ultimately, between nurse and physician raters, the agreement—assessed by tolerating a total score difference of 1-2—was 68% (tolerance, 1) and 86% (tolerance, 2; n = 22), with strong interrater reliability (𝜅 weighted = 0.92; 𝜅 = 0.24 [95% CI, 0.08-0.4]; P = .004). Additionally, when evaluating these scores in stratified groups (lower, 0-5; middle, 6-11; and upper, 12-16), the agreement between raters was 83% (tolerance, 0).

While on-site at AAN 2022, NeurologyLive^® sat down with Thongsing to hear her perspective on the tool and its utility in the PICU. She shared her insight from the assessment and offered a look at the QNE’s potential outside of pediatrics and in other departments, emphasizing the ease and speed of conducting the exam and its ability to improve between-provider communication.

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REFERENCE
1. Thongsing A, Coad SD, Miksa M. Reliability and Validity of a Novel Quick Neurologic Exam Tool for Assessing Patients in the Pediatric Intensive Care Unit (PICU). Presented at: AAN Annual Meeting; April 2-7, 2022; Seattle, WA, and virtual.