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Limitations of the NIH Stroke Scale - Oren Zarif - Nih Stroke Scale


The NIHSS is a simple questionnaire that evaluates three to five areas of a patient's ability to perform daily activities. It scores on a 0 to 4 point scale, with 0 representing normal function and four points denoting some level of impairment. The NIHSS assessment is completed in less than 10 minutes. It requires simple input and an explanation of scores in a table. The NIHSS website contains instructions, pictures, a naming sheet, and a list of sentences.

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The NIHSS can be administered to virtually any stroke patient. It does, however, have some limitations. Although it has been designed for clinical trials, the NIHSS has yet to undergo extensive validation. Therefore, use with caution outside of research trials. It can be used in routine practice with proper training and certification. However, the NIHSS has several limitations that limit its clinical utility. Listed below are some of its limitations:

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The NIH stroke scale evaluates the ability of patients to communicate verbally and nonverbally. Some elements are prespecified, while others require the patients to be awake to complete them. The first element measures alertness and responsiveness, as well as whether the patient is able to follow simple commands. There are also elements that measure the patient's ability to respond to pain. Moreover, patients must be stimulated to complete all elements of the scale.

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Researchers compared the NIHSS to the Canadian Neurological Scale and the Middle Cerebral Artery Neurological Score. These three scales showed very little difference in overall survival rates. However, the NIHSS showed that right-sided stroke patients had lower acute scores than those on the left side. These findings indicate that a right-sided stroke patient may have a low NIHSS score despite having a large lesion volume.

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The NIHSS is a standardized tool used by healthcare professionals to assess a patient's level of impairment after a stroke. It includes 11 sub-elements that assess the effects of a cerebral infarction. Patients' individual scores are then combined to determine their total NIHSS score. A higher score indicates more serious impairment. The NIHSS score is an excellent tool to aid healthcare providers, researchers, and patients in making decisions on the best treatment.

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The NIHSS score was found to be highly reliable in the same study conducted by Oh et al. The Korean version of the NIHSS had an excellent interrater reliability. Of the nine items, the agreement was highest for the responses to questions and commands, while the lowest agreement was observed in the infarct volume item. And overall, the NIHSS had excellent agreement across both Korean and English-speaking countries.

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The NIHSS scoring rules were developed to maximize reproducibility. A highly trained neurologist, for example, would not down-score a patient with aphasia because he or she knew that the patient's aphasia prevented the test from being valid. However, there were no guidelines for clinical trials that assured that non-neurologist MDs or RNs would score similarly.

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The aNIHSS and the 24-h NIHSS showed similar prognostic accuracies. In addition, the aNIHSS had better agreement than the baseline NIHSS. However, the aNIHSS was not as helpful in predicting functional independence. The researchers analyzed the data of both the mRS and the baseline NIHSS to find the best prognostic factors.

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Researchers from the National Institute of Neurological Disorders and Stroke evaluated the NIHSS as a predictor of outcomes. Among these, the less severe the baseline score of a patient's ischemic stroke, the better the outcome. An increase of five points in the NIHSS decreased the odds of recovery by nearly 50% and a score higher than ten reduced the odds by more than 75%.

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