Friday, January 22nd, 2021
National Institutes of Health Stroke Scale (NIHSS) is a clinical tool that measures stroke-related neurologic deficits. This measure can be quantified. NIHSS is used in modern neurology for three main objectives;
NIHSS was initially intended for research purposes. It was designed as a research tool in clinical trials for acute strokes to measure baseline data. It was used to assess the severity of ischemic stroke in controlled clinical studies.
NIHSS can be termed as a composite scale because it was derived from four other scales. The Toronto Stroke Scale, the Edinburgh-2 Coma Scale, Oxbury Initial Severity Scale and the Cincinnati Stroke Scale. It is designed to be a simple tool that can be used at the bedside consistently by healthcare providers like nurses, therapists and physicians.
Since this stroke scale is widely used, not only the caregivers of stroke patients must be informed about its works. The patients and their families should also be aware of how the scale works and how to read it.
NIHSS is a 15 item neurological tool, although some may say it has 11 elements because the first element is divided into three sub-elements 1a, 1b and 1c, while the fifth and sixth have two sub-elements each. These elements evaluate the effects of cerebral infarction. Each item’s ratings are scored on a point scale of three to five points with 0 being normal. Additionally, there is an allowance for things that are not testable. The score ranges from 0 to 42, with 42 being the highest possible score. When it comes to the NIHSS, the higher the score, the greater the severity of stroke. Therefore, a patient with a score of 35 has a higher severity risk compared to one with a score of 13.
An observer rates a patient depending on their ability to answer questions and perform some activities. This assessment per patient does not require a lot of time; usually, it takes less than ten minutes to be complete.
NIHSS scores may be used to stratify stroke severity as follows (Brott et al., 1989);
There are also outcomes related to NIHSS scores at admission, acute stroke (Schlegel et al., 2003; Rundek et al., 2000)
At times, the patients might seem to be struggling with the assessments, and all you want to do as a caregiver, a family member or an examiner is to help them get through this by assisting them or coaching them for the assessment. Your attempt to help, however genuine, does no good to the patient because then, the scores reflected on the evaluation are not entirely the patient’s effort. Therefore, the clinicians are not in a position to accurately tell the severity of the stroke. They might end up discharging a patient who needs in-patient rehabilitation. Therefore, it would be best if the patients were neither aided nor coached by anyone for their assessments. This way, the results would be accurate.
Here are the elements of the National Institutes of Health Stroke Scale;
The National Institutes of Health Stroke Scale requires observers to be adequately trained to use it accurately and effectively. A certified clinician should perform an assessment of a patient; a nurse, physician or therapist. The evaluation should be completed within twelve hours of admission, during the initial assessment before a t-PA decision. The stroke severity assessment majorly depends on the accuracy and consistency of the patient’s evaluation by an observer. It is, therefore, necessary to have adequate training.
To learn more about other important stroke-related scales and evaluations, visit www.neurorehabdirectory.com for more information.