Learn about the NIH Stroke Scale, a tool used by healthcare providers to objectively quantify stroke severity. This article covers the scale's history, scoring, role in diagnosis/treatment, benefits, limitations, and use in clinical practice.
What is the NIH Stroke Scale?
The NIH Stroke Scale (NIHSS) is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. It evaluates the effect of acute ischemic stroke on a patient's level of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss. The NIHSS is used upon hospital admission and during the patient's hospital stay to assess stroke severity, determine prognosis, and guide decisions around acute stroke treatment. Scores range from 0 to 42, with higher numbers indicating more severe strokes.
History of the NIH Stroke Scale
The NIH Stroke Scale was developed in 1989 by the National Institute of Neurological Disorders and Stroke (NINDS) as a quantitative way to evaluate acute stroke patients in clinical trials. Creation of the scale was funded by NINDS to meet a pressing need for standardized assessments in stroke research. The NIHSS was developed based on previously published stroke scales, with input from stroke experts. It has since been further validated and refined.
Scoring and Impairment Measures
The NIHSS evaluates the effect of stroke on 11 categories including consciousness, vision, sensation, movement, speech and language. Each category is scored based on the ability of the patient to perform a task, such as responding to commands or reading sentences. Higher scores indicate greater impairment, with a maximum score of 42. Information needed to score a patient is obtained through simple bedside assessments that can be performed by physicians, nurses or therapists. Results help quantify stroke severity and localize region(s) of the brain affected.
Role in Diagnosis and Treatment
Scores on the NIH Stroke Scale correlate with size of stroke, degree of damage, and prognosis. The scale helps healthcare providers make rapid diagnostic and treatment decisions. Patients with higher NIHSS scores have a greater risk of complications and higher mortality. The scale also predicts patient outcomes with and without use of the clot-busting drug tissue plasminogen activator (tPA). As such, the scale helps determine who may benefit from tPA treatment within the short therapeutic window.
Benefits
Key benefits of the NIH Stroke Scale include: - Provides objective, standardized stroke assessment - Quantifies neurological deficits - Can be administered rapidly - Guides diagnosis and acute treatment - Predicts prognosis and outcomes - Facilitates communication between providers - Useful in clinical trials and research
Limitations
Limitations of the scale include: - Less accurate with very mild or severe strokes - Administering requires training - Inter-rater reliability varies - Does not assess cognition or perceptual deficits - May miss subtle deficits - Limited usefulness after the acute phase - Does not account for side of stroke/dominant hemisphere
Use in Clinical Practice
The NIH Stroke Scale is widely used in emergency medicine and neurology to quantify neurological deficits in acute stroke patients. It is easy to learn and can be administered in about 5-10 minutes. The scale provides a snapshot of a patient's status and helps guide urgent decisions about treatment with thrombolytics. Serial assessments with the NIHSS during hospitalization also help evaluate any changes in the patient's status. Overall, the scale brings objectivity to the clinical bedside evaluation of stroke patients.
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NIH Stroke Scale Training
Proper training is essential for healthcare providers to accurately administer the NIH Stroke Scale. Training helps standardize assessments between different practitioners. Options include in-person workshops, online modules with certification, and supervised patient assessments.
Stroke Assessment Tools
The NIH Stroke Scale is one of several validated tools available to objectively evaluate and quantify stroke severity. Other common stroke assessment scales include the modified Rankin Scale, Barthel Index, and Glasgow Coma Scale.
tPA for Stroke
The clot busting drug tPA can significantly improve outcomes but must be given within 4.5 hours of symptom onset. NIH Stroke Scale scores help determine if a patient falls within the indicated parameters for tPA treatment.
Stroke Symptoms
Recognizing the signs and symptoms of stroke is key. The NIH Stroke Scale assesses symptoms like weakness, trouble speaking, vision loss, numbness, headache, and changes in alertness or consciousness.
F.A.S.T. Test for Stroke
F.A.S.T. stands for Facial drooping, Arm weakness, Speech difficulties, and Time to call 911. This simple test helps identify common stroke symptoms that correspond with the NIH Stroke Scale.
Stroke Risk Factors
Major risk factors for stroke include high blood pressure, heart disease, smoking, obesity, sedentary lifestyle, diabetes, high cholesterol, and family history. The NIH Stroke Scale helps assess severity once a stroke occurs.
Stroke Rehabilitation
Rehabilitation helps patients regain function after a stroke. Serial NIH Stroke Scale assessments can track recovery progress and functional improvements with occupational, physical, and speech therapy.
Stroke Statistics
Important stroke stats include stroke being the #5 cause of death, responsible for 1 in every 19 deaths. 795,000 people have a stroke annually in the US. The NIH Stroke Scale quantifies deficits.
Stroke Prevention
Strategies to help prevent stroke include controlling blood pressure, diet/nutrition, exercise, avoiding tobacco, limiting alcohol, and managing conditions like atrial fibrillation and diabetes.
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