Nihss scoring
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NIHSS Scoring: Insights and Applications
NIHSS Score and Arteriographic Findings in Acute Ischemic Stroke
The National Institutes of Health Stroke Scale (NIHSS) is a critical tool in assessing stroke severity and predicting outcomes. Research has shown a significant association between NIHSS scores and arteriographic findings in acute ischemic stroke patients. Higher NIHSS scores are strongly correlated with central occlusions in major arteries such as the basilar, internal carotid, and middle cerebral arteries. Specifically, NIHSS scores of 10 or higher have a positive predictive value (PPV) of 97% for carotid strokes and 96% for vertebrobasilar strokes, indicating a high likelihood of vessel occlusion . Furthermore, an NIHSS score of 12 or higher predicts central occlusions with a PPV of 91%.
Retrospective NIHSS Scoring Validity
Retrospective assessment of NIHSS scores using medical records has been validated as reliable and unbiased. Studies have demonstrated near-perfect interrater reliability and excellent agreement between prospective and retrospective NIHSS scores, even when some physical examination data are missing . This finding supports the use of NIHSS in retrospective stroke research, ensuring that differences in initial stroke severity can be accurately adjusted for in outcome analyses.
Expanded NIHSS for Posterior Circulation Strokes
The traditional NIHSS has limitations in evaluating posterior circulation strokes. To address this, the expanded NIHSS (e-NIHSS) includes additional elements to better capture signs and symptoms of posterior circulation strokes. Research indicates that the e-NIHSS provides a more accurate assessment for these types of strokes, with patients showing higher scores on the e-NIHSS compared to the traditional NIHSS, thus improving sensitivity and potentially impacting clinical trials and outcomes.
Predictive Value of Baseline NIHSS Scores
The predictive value of baseline NIHSS scores for functional outcomes has been debated, especially with the advent of acute stroke interventions. While baseline NIHSS scores are strong predictors of outcomes at 7 days and 3 months, their predictive accuracy diminishes compared to NIHSS scores taken at 24 hours or at discharge. This is particularly evident in patients undergoing mechanical thrombectomy, where 24-hour and discharge NIHSS scores show robust predictive accuracy .
NIHSS in Intracerebral Hemorrhage
Although primarily used for ischemic strokes, the NIHSS has also been shown to correlate with outcomes in intracerebral hemorrhage (ICH). Admission NIHSS scores are predictive of mortality and functional outcomes at 6 months, with higher scores indicating worse outcomes. This suggests that NIHSS can be a reliable tool for monitoring clinical progress in ICH patients.
Limitations of NIHSS in Chronic Stroke
The NIHSS is less effective in chronic stroke survivors. Studies have found no significant association between NIHSS scores and long-term health status measures such as the Stroke Impact Scale (SIS). This indicates that while NIHSS is valuable in the acute phase of stroke, it lacks validity for assessing long-term outcomes and health status in chronic stroke patients.
Conclusion
The NIHSS remains a vital tool in stroke assessment, with strong predictive value for acute ischemic stroke outcomes and vessel occlusions. Its reliability in retrospective scoring and expanded versions for posterior circulation strokes enhance its utility. However, its predictive accuracy diminishes over time, and it is less effective in chronic stroke assessment. These insights underscore the importance of context-specific application of the NIHSS in stroke management and research.
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