NIH Stroke Scale
Original Editor - Rachael Lowe
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Objective
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The National Institutes of Health Stroke Scale (NIHSS) is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit. The NIHSS was originally designed as a research tool to measure baseline data on patients in acute stroke clinical trials. Now, the scale is also widely used as a clinical assessment tool to evaluate acuity of stroke patients, determine appropriate treatment, and predict patient outcome.
The NIHSS can be used as a clinical stroke assessment tool to evaluate and document neurological status in acute stroke patients[1]. The stroke scale is valid for predicting lesion size and can serve as a measure of stroke severity. The NIHSS has been shown to be a predictor of both short and long term outcome of stroke patients[2]. Additionally, the stroke scale serves as a data collection tool for planning patient care and provides a common language for information exchanges among healthcare providers.
The scale is designed to be a simple, valid, and reliable tool that can be administered at the bedside consistently by physicians, nurses or therapists.
Intended Population
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Individuals with Stroke
Method of Use[edit | edit source]
The NIHSS is a 15-item neurologic 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. A trained observer rates the patent’s ability to answer questions and perform activities. Ratings for each item are scored with 3 to 5 grades with 0 as normal, and there is an allowance for untestable items. The single patient assessment requires less than 10 minutes to complete.
The evaluation of stroke severity depends upon the ability of the observer to accurately and consistently assess the patient.
Reference
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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.
Evidence[edit | edit source]
Reliability[edit | edit source]
Inter-rater reliability for individual elements of the NIHSS has been shown to be generally good[3][4]. However overall scoring can be inconsistent, proper training is required to use the NIH Stroke Scale acurately[5][6][7][8].
Validity[edit | edit source]
Responsiveness[edit | edit source]
Miscellaneous
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Links[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
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References
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- ↑ Spilker J1, 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
- ↑ 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.
- ↑ Goldstein LB1, Bertels C, Davis JN. Interrater reliability of the NIH stroke scale. Arch Neurol. 1989 Jun;46(6):660-2.
- ↑ 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.
- ↑ Goldstein LB, Samsa GP.. Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial. Stroke. 1997 Feb;28(2):307-10.
- ↑ 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.
