The Inter-rater Variability of Clinical Assessment in Post-anoxic Myoclonus

van Zijl, J. C., Beudel, M., Elting, J-W. J., de Jong, B. M., van der Naalt, J., van den Bergh, W. M., Rossetti, A. O., Tijssen, M. A. J. & Horn, J. 2017 In : Tremor and other hyperkinetic movements (New York, N.Y.). 7, 6 p.

Research output: Scientific - peer-reviewArticle

BACKGROUND: Acute post-anoxic myoclonus (PAM) can be divided into an unfavorable (generalized/subcortical) and more favorable ((multi)focal/cortical) outcome group that could support prognostication in post-anoxic encephalopathy; however, the inter-rater variability of clinically assessing these PAM subtypes is unknown.

METHODS: We prospectively examined PAM patients using a standardized video protocol. Videos were rated by three neurologists who classified PAM phenotype (generalized/(multi)focal), stimulus sensitivity, localization (proximal/distal/both), and severity (Clinical Global Impression-Severity Scale (CGI-S) and Unified Myoclonus Rating Scale (UMRS)).

RESULTS: Poor inter-rater agreement was found for phenotype and stimulus sensitivity (κ=-0.05), moderate agreement for localization (κ=0.46). Substantial agreement was obtained for the CGI-S (intraclass correlation coefficient (ICC)=0.64) and almost perfect agreement for the UMRS (ICC=0.82).

DISCUSSION: Clinical assessment of PAM is not reproducible between physicians, and should therefore not be used for prognostication. PAM severity measured by the UMRS appears to be reliable; however, the relation between PAM severity and outcome is unknown.

Original languageEnglish
Number of pages6
JournalTremor and other hyperkinetic movements (New York, N.Y.)
StatePublished - 2017


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