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What is the NIHSS Stroke Scale? - Oren Zarif - Nih Stroke Scale


The NIHSS is an assessment tool for the neurological condition of a stroke patient. It should be used as soon as possible after a stroke has occurred. The NIHSS should also be used periodically or whenever the patient's condition changes, so that healthcare professionals can track their progress. It is important to note that the NIHSS has certain prespecified values. For example, the scale may not be as accurate as a patient's MRI or CT scan.

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The NIHSS was originally developed for clinical trials and was initially used to collect baseline data for controlled clinical studies. In addition to assessing stroke severity, it was also used to assess the effects of ischemic stroke on patient-specific physical, psychological, and cognitive functions. However, the NIHSS is limited in its ability to accurately assess brain stem strokes, which are comparatively rare and may have a different natural history.

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The NIHSS has a 0 to 42 score, with higher scores indicating more severe disease. It was developed by a panel of experts following a modified Delphi process. Although originally intended to assess the effects of various clinical trial interventions, the NIHSS is increasingly being used as an initial assessment tool and for post-acute care planning. Its psychometric properties were recently demonstrated in a meta-analysis by Lyden et al.

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The NIHSS is a standardized tool used by healthcare professionals to evaluate the degree of impairment caused by a stroke. Each item on the scale scores ability between 0 and 4, with a score of zero representing normal function. A higher score indicates more severe impairment, whereas a low score indicates normal functioning. Using the NIHSS, clinicians can make informed treatment decisions for stroke patients. There are several benefits to this tool.

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The NIHSS is considered the gold standard for assessment of the neurological condition after a stroke. In a study of over 2,000 patients, it was found that a high score on the NIHSS was associated with better outcomes than lower scores. Moreover, one extra NIHSS score decreased the chances of excellent outcomes by 24%. The NIHSS score of seven to 10 was associated with an excellent outcome for 23% of patients and one point decreased the risk by 17% for those with a score of eleven to fifteen.

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Although the NIHSS is a useful tool for assessing patient health, there are still many questions related to reproducibility. One of the cardinal rules of the NIHSS is to score what you see. A skilled neurologist would not down-score a patient who has aphasia, for example, because she knows that this condition prevents valid testing of orientation. Similarly, there is no guarantee that non-neurologist physicians or RNs would score identically.

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Moreover, the NIHSS also has the ability to predict outcomes in patients who have undergone acute hospitalization. A study by Mur et al. (2002) evaluated the correlation between NIHSS and the Barthel Index. The NIHSS scores were found to be significantly related to length of stay, hospital charges, and discharge destination. Moreover, the NIHSS was also associated with a patient's Rankin score.

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In the NIHSS, patients with a score of eight or more are considered to have a major stroke. Patients with stroke below this threshold have a reasonable chance of a favorable outcome if they are untreated. However, recent RCTs have shown significant variability in the thresholds used to define a major stroke. The lowest threshold was 2 in the MRCLEAN trial. Another study, EXTEND-IA, didn't set a specific threshold. It deemed that a patient was "disable" before a stroke was diagnosed.

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Despite these limitations, the mNIHSS retains its excellent prognostic accuracy for a good outcome. It was also significantly more accurate than the baseline NIHSS. In addition, the aNIHSS scored nine or higher for very poor outcomes. Moreover, it was superior to the total 24-h NIHSS across 6 published datasets. This suggests that the mNIHSS may be a more effective tool for assessing stroke patients.

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The NIHSS contains eleven elements. Each element is assessed on a scale from 0 to four, with some elements having only a 0-to-2 scale. Typically, the higher the score, the more impaired the patient is. For instance, the first element is the level of consciousness, which includes three sub-elements evaluating the patient's alertness, responsiveness, and ability to follow simple commands.

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