It is crucial to be familiar with and use the NIH Stroke Scale (NIHSS) to objectively describe the extent of a stroke, in a language universal to all physicians, particularly our neurology colleagues.
This validated tool consists of 15 items and the scale ranges from 0-42. The higher the number, the worst the stroke.
The NIHSS does not have to be memorized, but rather accessible for reference when needed.
Studies have validated an abbreviated, 5-item NIHSS that has the same predictive performance as the 15-item scale. This scale ranges from 0-16.
While this abbreviated scale was created primarily for use in the prehospital setting, it can certainly be performed in the ED prior to rushing the patient off the CT for a head scan, in order to provide your neurologist with some objective information in a timely fashion.
The NIHSS-5 assesses the following functions, in decreasing order of importance in terms of prognosis:
-- motor function (right leg)
-- motor function (left leg)
-- gaze
-- visual fields
-- language
References
Tirschwell, et al. "Shortening the NIH Stroke Scale for Use in the Prehospital Setting." Stroke 2002; 33: 2801-2806.
