Overview of the NIH Stroke Scale for quantifying neurological deficit after stroke. Details scoring, interpretation, reliability, limitations and future innovations like the NIH Stroke Scale - Blue Cloud mobile assessment initiative.
Overview of the NIH Stroke Scale
The NIH Stroke Scale is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit. It was introduced in 1989 and modified over the subsequent decade. The NIH Stroke Scale serves several purposes, including evaluating initial stroke severity, monitoring for neurological worsening, and measuring recovery during and after stroke therapy.
Scoring the NIH Stroke Scale
The NIH Stroke Scale examines the effect of acute cerebrovascular injury on levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss. The scale includes 11 items, most of which are scored on a 0 to 4 scale, with 0 indicating normal function and 4 indicating severe impairment. The individual scores are summed to calculate a patient's total NIH Stroke Scale score. Higher scores indicate greater stroke severity.
Interpreting the NIH Stroke Scale
The total NIH Stroke Scale score gives a useful snapshot of a patient's overall neurological function. Most patients with acute ischemic stroke will present with moderately severe strokes and have NIH Stroke Scale scores in the 5 to 15 range. Scores of 16 or more indicate severe neurological impairment, while scores below 5 suggest a minor stroke. Repeated scoring over the first days after a stroke allows providers to determine whether a patient is improving, worsening or remaining neurologically stable.
Reliability of the NIH Stroke Scale
The NIH Stroke Scale has been extensively studied for reliability and validity. When administered by a trained provider, the scale demonstrates high interrater reliability. It also correlates well with lesion volume and functional outcome after stroke. The scale is less reliable when used by untrained physicians or across a telephone. As a result, certification training is recommended for any provider conducting repeated NIH Stroke Scale assessments as part of research protocols or clinical care pathways.
Limitations of the NIH Stroke Scale
While extremely useful, the NIH Stroke Scale has some limitations. Assessing isolated brainstem or cerebellar injury can be challenging. The scale may also underestimate cognitive deficits, visual impairments and limb ataxia. Serial NIH Stroke Scale scores demonstrate progression over the first 24 hours in only approximately 20% of patients, reducing its utility to identify early neurological deterioration compared to more frequent assessments. Finally, the scale's role is limited after the acute period when more detailed functional scales become preferable.
Electronic NIH Stroke Scale Software
In recent years, several electronic and tablet-based NIH Stroke Scale software options have emerged. These tools integrate the official NIH Stroke Scale slides and prompts and can increase scoring accuracy. Some versions, such as the NIH Stroke Scale International app, allow data capture for subsequent analytics. Other software, including Click Diagnostics' Stroke Scale app, focuses on mimicking a simple bedside paper assessment. While promising, more research is likely needed to demonstrate the reliability of electronic NIH Stroke Scale scoring in clinical care.
Future Directions for the NIH Stroke Scale
The NIH Stroke Scale has proven to be among the most robust, validated, and widely used assessments in all of clinical medicine over more than 30 years. Work continues to streamline and digitize the scale for the 21st century through efforts like the NIH Stroke Scale - Blue Cloud initiative. Blue Cloud aims to use mobile technology to capture serial NIH Stroke Scale data in real-time. Such analytics could detect early neurological changes, predict stroke complications, and speed research insights. Though modifications will continue, the essential utility of the NIH Stroke Scale is likely to persist given its track record of reliability and practicality at the bedside.
Several facts about nih stroke scale blue cloud
Stroke Scales
There are several standard stroke scales used to quantify impairment after stroke, such as the NIH Stroke Scale, the Canadian Neurological Scale and the Scandinavian Stroke Scale. They objectively measure neurological deficits in consciousness, strength, sensation and other domains.
Neurological Assessment
The NIH Stroke Scale allows rapid neurological assessment after stroke to establish severity, identify improvement or deterioration, prognosticate outcomes and assist with clinical decision making.
Acute Ischemic Stroke
The NIH Stroke Scale is most commonly used in patients with acute ischemic stroke caused by clots obstructing blood flow. It can help determine eligibility for IV tPA and thrombectomy treatments.
Interrater Reliability
If performed by trained personnel, the NIH Stroke Scale demonstrates consistent results between different raters evaluating the same patient, known as excellent interrater reliability.
Stroke Trials
The NIH Stroke Scale is used as a standardized assessment tool in most major stroke clinical trials evaluating new treatments and interventions.
Neurological Worsening
Frequent repeated administration of the NIH Stroke Scale can identify deteriorating neurological function known as stroke progression.
Telestroke
Telestroke platforms allow remote NIH Stroke Scale assessment in patients at spoke hospitals without on-site stroke expertise.
Secondary Stroke Prevention
The NIH Stroke Scale helps determine stroke severity and guides secondary prevention decisions like carotid endarterectomy for high-grade stenosis.
Rehabilitation
Serial administration of the NIH Stroke Scale during stroke rehabilitation allows objective quantification of neurological recovery.
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