BACKGROUND AND PURPOSE: The National Institute of Health Stroke Scale (NIHSS) is rapid and reproducible, a seemingly attractive metric for the documentation of clinical progress in patients presenting with ischemic stroke. Many institutions have adopted it into daily clinical practice. Unfortunately, the scale may not adequately capture all forms of functional change. We evaluate its utility as a measure of recovery in patients treated with intravenous tissue plasminogen activator (IV tPA) for ischemic stroke. METHODS: We prospectively evaluated the difference in the rate of improvement based on NIHSS (a ≥4 point change based on previous trials) versus physician-documented subjective and objective measures in 41 patients' status post IV tPA treatment. The NIHSS 24 hours posttreatment, on discharge, and at follow-up were compared to NIHSS on admission using tests of proportions and McNemar tests of paired data. Secondary analyses were performed defining significant improvement as NIHSS changes of 1 to 3 points. RESULTS: The mean NIHSS improved from 9 to 6, 24 hours post-tPA. Of the 41 patients, 29 improved by physician documentation, although only 11 of the 29 met the NIHSS criteria (P < .001; McNemar P < .001). On discharge, 20 of the 41 patients met the NIHSS criteria; however, the proportion "better" by physician documentation (71%) remained significantly higher (P = .04; McNemar P = .004). The mean postdischarge follow-up NIHSS was 2. Twenty of the 21 patients improved by documentation versus 16 of the 21 by NIHSS (P = .08, McNemar P = .125). Using NIHSS changes of 1 to 3 increased sensitivity for detecting improvement but remained lower than physician documentation. CONCLUSION: The NIHSS has many advantages; however, it may miss functional changes when used in place of a comprehensive neurological examination to measure improvement poststroke.
BACKGROUND AND PURPOSE: The National Institute of Health Stroke Scale (NIHSS) is rapid and reproducible, a seemingly attractive metric for the documentation of clinical progress in patients presenting with ischemic stroke. Many institutions have adopted it into daily clinical practice. Unfortunately, the scale may not adequately capture all forms of functional change. We evaluate its utility as a measure of recovery in patients treated with intravenous tissue plasminogen activator (IV tPA) for ischemic stroke. METHODS: We prospectively evaluated the difference in the rate of improvement based on NIHSS (a ≥4 point change based on previous trials) versus physician-documented subjective and objective measures in 41 patients' status post IV tPA treatment. The NIHSS 24 hours posttreatment, on discharge, and at follow-up were compared to NIHSS on admission using tests of proportions and McNemar tests of paired data. Secondary analyses were performed defining significant improvement as NIHSS changes of 1 to 3 points. RESULTS: The mean NIHSS improved from 9 to 6, 24 hours post-tPA. Of the 41 patients, 29 improved by physician documentation, although only 11 of the 29 met the NIHSS criteria (P < .001; McNemar P < .001). On discharge, 20 of the 41 patients met the NIHSS criteria; however, the proportion "better" by physician documentation (71%) remained significantly higher (P = .04; McNemar P = .004). The mean postdischarge follow-up NIHSS was 2. Twenty of the 21 patients improved by documentation versus 16 of the 21 by NIHSS (P = .08, McNemar P = .125). Using NIHSS changes of 1 to 3 increased sensitivity for detecting improvement but remained lower than physician documentation. CONCLUSION: The NIHSS has many advantages; however, it may miss functional changes when used in place of a comprehensive neurological examination to measure improvement poststroke.
Authors: M Planton; S Peiffer; J F Albucher; E J Barbeau; J Tardy; J Pastor; A C Januel; C Bezy; B Lemesle; M Puel; J F Demonet; F Chollet; J Pariente Journal: Eur J Neurol Date: 2011-06-01 Impact factor: 6.089
Authors: S E Kasner; J A Chalela; J M Luciano; B L Cucchiara; E C Raps; M L McGarvey; M B Conroy; A R Localio Journal: Stroke Date: 1999-08 Impact factor: 7.914
Authors: Chelsea S Kidwell; Reza Jahan; Jeffrey Gornbein; Jeffry R Alger; Val Nenov; Zahra Ajani; Lei Feng; Brett C Meyer; Scott Olson; Lee H Schwamm; Albert J Yoo; Randolph S Marshall; Philip M Meyers; Dileep R Yavagal; Max Wintermark; Judy Guzy; Sidney Starkman; Jeffrey L Saver Journal: N Engl J Med Date: 2013-02-08 Impact factor: 91.245
Authors: Joseph P Broderick; Yuko Y Palesch; Andrew M Demchuk; Sharon D Yeatts; Pooja Khatri; Michael D Hill; Edward C Jauch; Tudor G Jovin; Bernard Yan; Frank L Silver; Rüdiger von Kummer; Carlos A Molina; Bart M Demaerschalk; Ronald Budzik; Wayne M Clark; Osama O Zaidat; Tim W Malisch; Mayank Goyal; Wouter J Schonewille; Mikael Mazighi; Stefan T Engelter; Craig Anderson; Judith Spilker; Janice Carrozzella; Karla J Ryckborst; L Scott Janis; Renée H Martin; Lydia D Foster; Thomas A Tomsick Journal: N Engl J Med Date: 2013-02-07 Impact factor: 91.245
Authors: Rebecca F Gottesman; Jonathan T Kleinman; Cameron Davis; Jennifer Heidler-Gary; Melissa Newhart; Argye E Hillis Journal: Behav Neurol Date: 2010 Impact factor: 3.342
Authors: Carmen E Capo-Lugo; Robert L Askew; Kathryn Muldoon; Matthew Maas; Eric Liotta; Shyam Prabhakaran; Andrew Naidech Journal: Arch Phys Med Rehabil Date: 2019-12-23 Impact factor: 3.966
Authors: J Lanzone; M A Colombo; S Sarasso; F Zappasodi; M Rosanova; M Massimini; V Di Lazzaro; G Assenza Journal: Clin Neurophysiol Date: 2022-03-08 Impact factor: 4.861
Authors: Eric L Stulberg; Liming Dong; Alexander R Zheutlin; Sehee Kim; Edward S Claflin; Lesli E Skolarus; Lewis B Morgenstern; Lynda D Lisabeth Journal: J Am Heart Assoc Date: 2019-08-19 Impact factor: 5.501
Authors: Dimitris K Agrafiotis; Eric Yang; Gary S Littman; Geert Byttebier; Laura Dipietro; Allitia DiBernardo; Juan C Chavez; Avrielle Rykman; Kate McArthur; Karim Hajjar; Kennedy R Lees; Bruce T Volpe; Michael Krams; Hermano I Krebs Journal: PLoS One Date: 2021-01-29 Impact factor: 3.240