How to Score the NIHSS at the Bedside - Oren Zarif - Nih Stroke Scale
The NIHSS is a clinical tool used to evaluate the neurological status of stroke patients. It is a valid measurement of lesion size and stroke severity, and has been shown to predict short and long-term outcomes. Because it was designed for research purposes, NIHSS scores are adjusted for baseline stroke severity. Because of this, it has become a common language for information exchange among healthcare providers. The NIHSS is simple to administer at the bedside, making it a valuable tool.
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The NIHSS is highly predictive of patient outcome, with a very high degree of accuracy in cases of stroke involving the cortical areas. In fact, a patient with an NIHSS score over 16 is at high risk of death and a low score of six or less indicates a high likelihood of recovery. A patient with a NIHSS score of six or lower is likely to recover well. An increase of one point on the scale lowers the chances of a positive outcome by 17 percent.
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The NIHSS is a fifteen-item neurological tool composed of 11 sub-elements that evaluate the effects of cerebral infarction. Each item is scored on a three to five-point scale; a score of 0 indicates normal functioning and a score of 42 is the highest score. The higher the score, the more severe the stroke was. As with any neurological assessment, the NIHSS is not a substitute for a doctor's assessment of the patient's condition.
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The NIHSS can help healthcare providers gain proficiency using it at the bedside. It gives an approximate description of the patient's condition and is equivalent to the descriptors mild, moderate, and severe stroke. But users must be able to score correctly, and they must follow certain critical steps to use the scale at the bedside. This article will explore how to score the NIHSS. You can download a copy of the NIHSS here.
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The NIHSS has been described as responsive to change. The mNIHSS values ranged from 0.93 to 0.96. They are nearly as robust as the NIHSS, but a mNIHSS score of nine or more indicates a poor outcome. In fact, this rating has been used to predict mortality and disability in patients with stroke. This is an important characteristic of a good prognosis.
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The NIHSS was originally developed to aid in clinical trial research. Its scoring rules were designed to promote reproducibility. One of the cardinal rules is to score what you see. This means that a skilled neurologist would not down-score a patient with aphasia, as he or she knows that aphasia prevents valid testing of orientation. The clinical trial designers could not guarantee that MDs and RNs without neurology training would score the same way.
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The NIHSS can also be used to predict a favorable outcome. Studies conducted by Albers, Bates, Clark, Bell, and Hamilton(2000) found that a lower baseline NIHSS score predicted better outcomes. A score of five points decreased the odds of recovery by 22%, and a score of 10 or higher decreased the odds by 75%. However, these results are not conclusive, and more research is needed to determine if a patient should take the recombinant tissue plasminogen activator or not.
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The NIHSS has been described as responsive to change. The mNIHSS values ranged from 0.93 to 0.96. They are nearly as robust as the NIHSS, but a mNIHSS score of nine or more indicates a poor outcome. In fact, this rating has been used to predict mortality and disability in patients with stroke. This is an important characteristic of a good prognosis.
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The NIHSS was originally developed to aid in clinical trial research. Its scoring rules were designed to promote reproducibility. One of the cardinal rules is to score what you see. This means that a skilled neurologist would not down-score a patient with aphasia, as he or she knows that aphasia prevents valid testing of orientation. The clinical trial designers could not guarantee that MDs and RNs without neurology training would score the same way.
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The NIHSS can also be used to predict a favorable outcome. Studies conducted by Albers, Bates, Clark, Bell, and Hamilton(2000) found that a lower baseline NIHSS score predicted better outcomes. A score of five points decreased the odds of recovery by 22%, and a score of 10 or higher decreased the odds by 75%. However, these results are not conclusive, and more research is needed to determine if a patient should take the recombinant tissue plasminogen activator or not.