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

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.摘要 背景：推荐采用国际标准化工具辅助医护人员精准早期识别脑卒中。翻译与跨文化调适流程对确保不同语言环境下量表解读的一致性、进而保障其在多国的适用性具有重要意义。目的：以巴西人群代表性样本为依托，将辛辛那提院前脑卒中量表（Cincinnati Prehospital Stroke Scale）翻译成巴西葡萄牙语并完成跨文化调适与验证。方法：本研究纳入巴西急诊医疗服务中收治并转诊至脑卒中中心的疑似脑卒中患者，对原量表开展系统性翻译与跨文化调适，并应用最终版本工具。采用统计学分析评估该量表的灵敏度、特异度与准确度，使用科恩kappa系数（Cohen’s kappa coefficient）评估评定者间信度。结果：经翻译与跨文化调适后，该量表应用于64例患者。相较于最终金标准（gold standard）诊断，其准确度达93.0%，灵敏度为92.4%。针对26例患者（占比40.6%）的数据计算科恩kappa系数，结果显示量表各条目间具有极佳的评定者间信度（0.8385~1.0000）。结论：该量表展现出极佳的准确度、灵敏度与评定者间信度，可作为辅助医护人员对疑似脑卒中患者开展初始评估的实用工具，以简便快捷的方式显著助力脑卒中的早期识别。