NIH Stroke Scale: Difference between revisions
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== Method of Use == | == Method of Use == | ||
The NIHSS is a 15-item neurological examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss<ref name=":0" />. A trained observer rates the patent’s ability to answer questions and perform activities | The NIHSS is a 15-item neurological examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of [[Disorders of Consciousness|consciousness]], language, neglect, visual-field loss, extraocular movement, [[Muscle Strength Testing|motor strength]], [[ataxia]], [[dysarthria]], and [[Sensation|sensory loss]]<ref name=":0" />. A trained observer rates the patent’s ability to answer questions and perform activities, without coaching and without making assumptions about what the patient can do<ref>Know Stroke. NIH Stroke Scale. Available from https://www.stroke.nih.gov/resources/scale.htm (Accessed 12/07/2022)</ref>. | ||
Ratings for each item are scored on a 3- to 5-point scale, with 0 as normal, and there is an allowance for untestable items. Scores range from 0 to 42, with higher scores indicating greater severity. | |||
Stroke severity may be stratified on the basis of NIHSS scores as follows:<ref name="brott">Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. [https://pubmed.ncbi.nlm.nih.gov/2749846/ Measurements of acute cerebral infarction: a clinical examination scale]. 1989. Stroke 20(7): 864-870.</ref> | |||
*Very Severe: >25 | *Very Severe: >25 | ||
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*Mild to Moderately Severe: 5 – 14 | *Mild to Moderately Severe: 5 – 14 | ||
*Mild: 1 – 5 | *Mild: 1 – 5 | ||
{{#ev:youtube|do2CbY_Nm5c|300}} | {{#ev:youtube|do2CbY_Nm5c|300}} | ||
Revision as of 08:36, 12 July 2022
Original Editor - Rachael Lowe
Top Contributors - Admin, Chloe Waller, Kim Jackson, Adam Vallely Farrell, Oyemi Sillo, WikiSysop, Karen Wilson, 127.0.0.1, Tony Lowe, Evan Thomas, Naomi O'Reilly and Garima Gedamkar
Objective[edit | edit source]
The National Institutes of Health Stroke Scale (NIHSS) is a systematic, quantitative assessment tool to measure stroke-related neurological deficit[1]. In clinical practice it can be used to evaluate and document neurological status in acute stroke patients, determine appropriate treatment and assist in standardizing communication between healthcare practitioners[2]. The NIHSS has been shown to be a predictor of both short and long term outcomes of stroke patients[3][4].
The NIHSS is designed to be a simple tool that can be administered in less than 10 minutes by physicians, nurses or therapists[1].
Intended Population[edit | edit source]
Acute stroke patients[2].
Method of Use[edit | edit source]
The NIHSS is a 15-item neurological examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss[1]. A trained observer rates the patent’s ability to answer questions and perform activities, without coaching and without making assumptions about what the patient can do[5].
Ratings for each item are scored on a 3- to 5-point scale, with 0 as normal, and there is an allowance for untestable items. Scores range from 0 to 42, with higher scores indicating greater severity.
Stroke severity may be stratified on the basis of NIHSS scores as follows:[6]
- Very Severe: >25
- Severe: 15 – 24
- Mild to Moderately Severe: 5 – 14
- Mild: 1 – 5
Evidence[edit | edit source]
Reliability[edit | edit source]
Inter-rater reliability for individual elements of the NIHSS has been shown to be generally good[7]. However overall scoring can be inconsistent, proper training is required to use the NIH Stroke Scale accurately[8][9][10].
- A study of 4 patients assessed by 30 physicians and 29 study coordinators, with a space of 3 months between assessments, found that the NIHSS has excellent interrater (ICC = 0.95) and test-retest reliability (ICC = 0.93)
- A study of 20 patients rated by 4 clinicians, with each patient subsequently evaluated by 2 independent observers found Adequate to Excellent interrater agreement for 9 of the 13 items on the NIHSS (Kappa = 0.32 to 0.79); lowest levels of agreement were found for the Facial palsy (Kappa = 0.22) and limb ataxia (Kappa = -0.16) items.
- 4 items have poorly reliability or are redundant (level of consciousness, facial weakness, ataxia, and dysarthria[11]
Validity[12][13][edit | edit source]
Outcomes related to NIHSS scores at admission:
- Scores of <5; 80% of stroke survivors will be discharged to home
- Score between 6 and 13 typically require acute inpatient rehabilitation
- Scores of >14 frequently require long-term skilled care
Responsiveness[6][edit | edit source]
NIHSS scores were compared to infarction size (measured by computed tomography) on 65 patients at 1 week post stroke. 10 items demonstrated an average of 25% change over 7 days. However, changes in limb ataxia and best gaze may have been overstated.
Links[edit | edit source]
NIH Stroke Assessment Tool PDF
References[edit | edit source]
- ↑ 1.0 1.1 1.2 NIH Stroke Scale. Approach to Human Subject Protection and Patient Safety. Available from: https://www.nihstrokescale.org/ (Accessed 12/07/2022)
- ↑ 2.0 2.1 Spilker J, Kongable G, Barch C, Braimah J, Brattina P, Daley S, Donnarumma R, Rapp K, Sailor S. Using the NIH Stroke Scale to assess stroke patients. The NINDS rt-PA Stroke Study Group. J Neurosci Nurs. 1997 Dec;29(6):384-92.
- ↑ H.P. Adams Jr., P.H. Davis, E.C. Leira, K.-C. Chang, B.H. Bendixen, W.R. Clarke, R.F. Woolson, Hansen, MS. Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology July 1, 1999 vol. 53 no. 1 126
- ↑ Runde D. Calculated Decisions: NIH stroke scale/score (NIHSS). Emerg Med Pract. 2020 Jul 15;22(7):CD6-CD7.
- ↑ Know Stroke. NIH Stroke Scale. Available from https://www.stroke.nih.gov/resources/scale.htm (Accessed 12/07/2022)
- ↑ 6.0 6.1 Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. 1989. Stroke 20(7): 864-870.
- ↑ Josephson SA1, Hills NK, Johnston SC.. NIH Stroke Scale reliability in ratings from a large sample of clinicians. Cerebrovasc Dis. 2006;22(5-6):389-95.
- ↑ André C. The NIH Stroke Scale is unreliable in untrained hands. J Stroke Cerebrovasc Dis. 2002 Jan-Feb;11(1):43-6.
- ↑ Lyden P1, Raman R, Liu L, Emr M, Warren M, Marler J. National Institutes of Health Stroke Scale certification is reliable across multiple venues. Stroke. 2009 Jul;40(7):2507-11.
- ↑ Lyden P, Raman R, Liu L, Grotta J, Broderick J, Olson S, Shaw S, Spilker J, Meyer B, Emr M, Warren M, Marler J. NIHSS training and certification using a new digital video disk is reliable. Stroke. 2005 Nov;36(11):2446-9.
- ↑ Kasner, S. E. (2006). "Clinical interpretation and use of stroke scales." Lancet Neurol 5(7): 603-612.
- ↑ Schlegel, D., Kolb, S. J., et al. (2003). "Utility of the NIH Stroke Scale as a predictor of hospital disposition." Stroke 34: 134-137.
- ↑ Rundek, T., Mast, H., et al. (2000). "Predictors of resource use after acute hospitalization: the Northern Manhattan Stroke Study." Neurology 55: 1180-1187.