Reliability and Validity of the National Institutes of Health Stroke Scale for Neuroscience Nurses

Abstract

The National Institutes of Health Stroke Scale (NIHSS) is used widely among stroke neurologists and neuroscience nurses. It is most commonly used with acute ischemic stroke (AIS) but is also used to assess patients after hemorrhagic stroke or a suspected transient ischemic attack. The scale is used widely to assess patient status acutely, to assess treatment efficacy, and to predict outcome. This article provides a review of pertinent information about the reliability, validity, instruction, and competency on the scale for neuroscience nurses. The NIHSS was introduced as a 15-item scale, later reduced to 14 items developed by stroke neurologists from the University of Cincinnati, the University of Iowa and the National Institutes of Health-National Institute of Neurological Disorders and Stroke.1,2 This graded physical examination is a measure of impairment that assesses level of consciousness using 3 items, speech, language, cognition, inattention, visual field abnormalities, motor strength (4 items), sensory impairment, and ataxia. It was designed specifically for AIS clinical trials, and potential scores range from 0 to 42. A modified version that removed the initial level of consciousness item, as well as the ataxia, facial weakness, and dysarthria items resulted in an 11-item scale with potential scores ranging from 0 to 31.3 Training and certification in use of the NIHSS are recommended.4 Formal training can be found in ≥2 places (www.strokeassociation.com or www.ninds.gov). Since the success of the National Institute of Neurological Disorders and Stroke intravenous recombinant tissue plasminogen activator (rt-PA) trial, it has been acknowledged that performing and documenting a physical examination in the most efficient and useful manner is a key element of nursing care for the patient with AIS.5 The most efficient manner for assessing patients who are awake is to use the NIHSS. In AIS it is advisable for the …