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(Stroke. 2009;40:2557.)
© 2009 American Heart Association, Inc.

Research Letters

Development of the Italian Version of the National Institutes of Health Stroke Scale

It-NIHSS

Francesca Romana Pezzella, MD, PhD; Orietta Picconi, BS; Assunta De Luca, MD; Patrick D. Lyden, MD, FAAN Marco Fiorelli, MD, PhD

From the Department of Neurological Sciences (F.R.P.), Sapienza University of Rome, Viale dell’Università, Rome, Italy; ASP-Lazio (O.P., A.D.L.), Public Health Agency of Lazio Region, Rome, Italy; the Department of Neurology (P.D.L.), Veterans Affair Medical Center, San Diego, and the Department of Neurosciences (P.D.L.), University of California, San Diego School of Medicine, San Diego, Calif; and the Department of Neurological Sciences (M.F.), Sapienza University of Rome, Rome, Italy.

Correspondence to Marco Fiorelli, MD, PhD, Department of Neurological Sciences, Sapienza University of Rome, Viale dell’Università, 30, 00185 Rome, Italy. E-mail marco.fiorelli{at}uniroma1.it

Background and Purpose— The National Institutes of Health Stroke Scale (NIHSS) is a basic component of the assessment of patients with acute stroke. To foster and standardize the use of the NIHSS among Italian health professionals, we translated the scale, dubbed into Italian the training and test videotapes devised by the National Institutes of Health researchers, and conducted a series of certification courses using the translated videos.

Methods— Translation, text adaptation, video dubbing, and editing of the Italian NIHSS videotapes relied on a team of bilingual stroke neurologists. Three waves of training courses were organized for mixed classes of medical and nonmedical health professionals. The certification test was based on the usual set of 5 videotaped patients. Scoring rules were those provided by the National Institutes of Neurological Disorders and Stroke. Reliability of the Italian NIHSS was assessed using kappa statistics and compared with that of the original NIHSS.

Results— During 3 years, 850 nurses, 460 nonneurologist physicians, and 246 neurologists were trained. Pass rates were respectively 44%, 75%, and 87%, respectively. Overall, 80% of scale items showed moderate to excellent reliability. Independent significant predictors of test failure at multivariate logistic regression were nurse profession (OR, 5.41; 95% CI, 4.07 to 7.20), older age (OR, 1.03; 95% CI, 1.02 to 1.05), and first edition of the course (OR, 3.13; 95% CI, 2.43 to 4.05). The agreement across all items between NIHSS and the Italian NIHSS was 80% (kappa=0.70±0.18, z<0.001).

Conclusions— The Italian translation, supervised by experienced vascular neurologists, did not influence the clinimetric characteristics of the NIHSS. Our findings support the implementation of NIHSS video training in languages other than English.

Key Words: observer variation • stroke assessment • stroke scales

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