This Article Full Text Full Text (PDF) All Versions of this Article: 33/12/2801    most recent 01.STR.0000044166.28481.BCv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tirschwell, D. L. Articles by Morgenstern, L. B. Search for Related Content PubMed PubMed Citation Articles by Tirschwell, D. L. Articles by Morgenstern, L. B. Related Collections Acute Stroke Syndromes Emergency treatment of Stroke Other Stroke

(Stroke. 2002;33:2801.)
© 2002 American Heart Association, Inc.

Original Contributions

Shortening the NIH Stroke Scale for Use in the Prehospital Setting

David L. Tirschwell, MD; W.T. Longstreth, Jr, MD; Kyra J. Becker, MD; Richard E. Gammans, Sr, PhD; LuAnn A. Sabounjian, RN, BSN; Scott Hamilton, PhD Lewis B. Morgenstern, MD

From the Departments of Neurology (D.L.T., W.T.L., K.J.B.) and Epidemiology (W.T.L.), Harborview Medical Center, University of Washington School of Medicine, Seattle; MSM INCARA Pharmaceutical Corp and Aeolus Pharmaceuticals, Inc (R.E.G.), Research Triangle Park, NC; Interneuron Pharmaceuticals, Inc (L.A.S.), Lexington, Mass; the Department of Neurology (S.H.), Stanford University School of Medicine, Stanford, Calif; and the Department of Neurology (L.B.M.), University of Michigan, Ann Arbor.

Correspondence to David L. Tirschwell, MD, Department of Neurology, Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Ave, Box 359775, Seattle, WA 98104-2499. E-mail tirsch{at}u.washington.edu

Background and Purpose— Prehospital stroke scales should identify stroke patients and measure stroke severity. The goal of this study was to identify a subset of the 15 items in the National Institutes of Health Stroke Scale (NIHSS-15) that measures stroke severity and predicts outcomes.

Methods— Using 2 distinct data sets from acute stroke clinical trials, we derived and validated shortened versions of the NIHSS (sNIHSS). Stepwise logistic regression and bootstrap techniques were used in selection of NIHSS-15 items. Areas under the receiver operator characteristic curve (C statistics) were used to compare predictive performance of logistic models incorporating differing versions of the NIHSS.

Results— The derivation analyses suggested the 8 NIHSS-15 items that were most predictive of "good outcome" 3 months after stroke, in order of decreasing importance: right leg item, left leg, gaze, visual fields, language, level of consciousness, facial palsy, and dysarthria. The sNIHSS-8 comprises all 8 and the sNIHSS-5, the first 5. In the validation models, C statistics were NIHSS-15=0.80, sNIHSS-8=0.77, and sNIHSS-5=0.76. Statistical comparisons suggested that the NIHSS-15 had better predictive performance than the sNIHSS-8 or the sNIHSS-5; the absolute difference in C statistics was small. There was no significant difference between the sNIHSS-8 and the sNIHSS-5.

Conclusions— Much of the predictive performance of the full NIHSS-15 was retained with a shortened scale, the sNIHSS-5. Shortening the NIHSS-15 will facilitate its use during prehospital evaluations. The sNIHSS severity information may be useful to triage acute stroke patients in communities and to provide a baseline stroke severity for prehospital acute stroke trials.

Key Words: cerebrovascular accident • emergency medical services

This article has been cited by other articles:

				D. Summers, A. Leonard, D. Wentworth, J. L. Saver, J. Simpson, J. A. Spilker, N. Hock, E. Miller, P. H. Mitchell, and on behalf of the American Heart Association Counci Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient: A Scientific Statement From the American Heart Association Stroke, August 1, 2009; 40(8): 2911 - 2944. [Full Text] [PDF]

				B. Nazliel, S. Starkman, D. S. Liebeskind, B. Ovbiagele, D. Kim, N. Sanossian, L. Ali, B. Buck, P. Villablanca, F. Vinuela, et al. A Brief Prehospital Stroke Severity Scale Identifies Ischemic Stroke Patients Harboring Persisting Large Arterial Occlusions Stroke, August 1, 2008; 39(8): 2264 - 2267. [Abstract] [Full Text] [PDF]

				J. E. Acker III, A. M. Pancioli, T. J. Crocco, M. K. Eckstein, E. C. Jauch, H. Larrabee, N. M. Meltzer, W. C. Mergendahl, J. W. Munn, S. M. Prentiss, et al. Implementation Strategies for Emergency Medical Services Within Stroke Systems of Care: A Policy Statement From the American Heart Association/ American Stroke Association Expert Panel on Emergency Medical Services Systems and the Stroke Council Stroke, November 1, 2007; 38(11): 3097 - 3115. [Full Text] [PDF]

				R. Dominguez, J. F. Vila, F. Augustovski, V. Irazola, P. R. Castillo, R. R. Escalante, T. G. Brott, and J. F. Meschia Spanish Cross-Cultural Adaptation and Validation of the National Institutes of Health Stroke Scale Mayo Clin. Proc., April 1, 2006; 81(4): 476 - 480. [Abstract] [Full Text] [PDF]

				O. C. Singer, F. Dvorak, R. du Mesnil de Rochemont, H. Lanfermann, M. Sitzer, and T. Neumann-Haefelin A Simple 3-Item Stroke Scale: Comparison With the National Institutes of Health Stroke Scale and Prediction of Middle Cerebral Artery Occlusion Stroke, April 1, 2005; 36(4): 773 - 776. [Abstract] [Full Text] [PDF]

				J. R. Fulgham, T. J. Ingall, L. G. Stead, H. J. Cloft, E. F. M. Wijdicks, and K. D. Flemming Management of Acute Ischemic Stroke Mayo Clin. Proc., November 1, 2004; 79(11): 1459 - 1469. [Abstract] [PDF]

				OTHER ARTICLES NOTED (24 Jan 03 to 18 Apr 03) Evid. Based Nurs., July 1, 2003; 6(3): e1 - 12. [Full Text] [PDF]