UMEM Educational Pearls

Category: Neurology

Title: Should We Use a Modified NIH Stroke Scale?

Keywords: Stroke, NIH stroke scale, NIHSS (PubMed Search)

Posted: 12/9/2015 by WanTsu Wendy Chang, MD
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Should We Use a Modified NIH Stroke Scale?

The NIH Stroke Scale (NIHSS) is a widely used scale in assessing neurological deficits in stroke patients.
It is a useful communication tool and is accurate in predicting clinical outcomes.
However, it has been critiqued for its complexity and potential poor interrater reliability of certain items within the scale.
Prior studies have suggested modifying or shortening the scale to 11, 8 or 5 items for use in stroke clinical trials or the prehospital setting.^1,2,3

A recent study compared the original NIHSS with the shortened 11, 8, and 5 item versions.⁴

They found the original NIHSS has higher discriminatory value and responsiveness to change as well as improved ability to predict clinical outcomes than shortened versions.

Bottom Line: The original 15-item NIHSS should still be used to evaluate patients’ stroke severity.

The reliability of the NIHSS has been found to improve with personal and videotaped training.

Lyden PD, Lu M, Levine SR, et al. A modified National Institutes of Health Stroke Scale for use in stroke clinical trials: preliminary reliability and validity. Stroke. 2001;32:1310-1317.
Meyer BC, Hemmen TM, Jackson CM, et al. Modified National Institutes of Health Stroke Scale for use in stroke clinical trials: prospective reliability and validity. Stroke. 2002;33:1261-1266.
Tirschwell DL, Longstreth WT, Becker KJ, et al. Shortening the NIH Stroke Scale for use in the prehospital setting. Stroke. 2002;33:2801-2806.
Lee CF, Venketasubramanian N, Wong KS, et al. Comparison between the original and shortened versions of the National Institutes of Health Stroke Scale in ischemic stroke patients of intermediate severity. Stroke 2015 Dec 1 [epub ahead of print].

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