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

The resident physician at Montefiore Medical Center shared her experience with the novel and standardized quick examination tool and the data presented at AAN 2022. [WATCH TIME: 3 minutes]

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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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.