- While the NIH Stroke Scale (NIHSS) may be relatively cumbersome and quite comprehensive, it is an extremely important tool that must not be ignored; it serves as a "common language" between emergency physicians and neurologists and often significantly shapes the management of acute ischemic stroke patients.
- Its prognostic usefulness (i.e. in cases wherein treatment is not initiated) has been validated and should be applied in emergent settings to determine optimal patient candidates for tPA treatment.
- For example, NIHSS > 20 in patients over 75 years old = 45% mortality; NIHSS >17 in patients with atrial fibrillation = positive predictive value for poor outcome of 96%; NIHSS of 6 or less = good spontaneous recovery.
- An abbreviated version of the NIHSS has been validated and assesses those components which are the best indicators of prognosis. Therefore, when unable to perform a full NIHSS, one should strongly consider using this tool rather than not performing a stroke scale assessment at all.
- This abbreviated version consists of only 5 categories which assess ability to see (1. best gaze; 2. best visual), walk (3. motor function of left leg; 4. motor function of right leg), and talk (5. best language). Can patient "see, walk, and talk?" This scale is scored from 0 to 16, with 16 representing the worst prognosis. (see attached abbreviated NIHSS).
References
- The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581-1587, 1995.
- Tirschwell, et al. "Shortening the NIH Stroke Scale for Use in the Prehospital Setting." Stroke 2002; 33: 2801-2806.
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