Anything that uses the National Institutes of Health Stroke Scale for measurement is worthless because of subjectivity. You should have written up a protocol on when it is useful instead of just this lazy research paper.
The NIH Stroke Scale Has Limited Utility in Accurate Daily Monitoring of Neurologic Status
- Elisabeth B. Marsh, MD1⇑
- Erin Lawrence, RN, MSN1
- Rebecca F. Gottesman, MD, PhD1
- Rafael H. Llinas, MD1
- Elisabeth B. Marsh, Department of Neurology, The Johns Hopkins School of Medicine, 600 North Wolfe St, Phipps 446C, Baltimore, MD 21287, USA. Email: ebmarsh@jhmi.edu
Abstract
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.
Only 2 of the 11 NIHSS test items look at motor skills. These 2 items ask stroke survivors to lift their affected arm and then leg to see if the limb remains still, drifts, or falls. This is a really crude assessment.
ReplyDelete