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NIH Stroke Scale

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1. Design and validation of a clinical scale for prehospital stroke recognition, severity grading and prediction of large vessel occlusion: the shortened NIH Stroke Scale for emergency medical services. (Full text)

Design and validation of a clinical scale for prehospital stroke recognition, severity grading and prediction of large vessel occlusion: the shortened NIH Stroke Scale for emergency medical services. To develop an NIH Stroke Scale (NIHSS)-compatible, all-in-one scale for rapid and comprehensive prehospital stroke assessment including stroke recognition, severity grading and progression monitoring as well as prediction of large vessel occlusion (LVO).Emergency medical services (EMS) personnel (...) , the final scale (termed shortened NIHSS for EMS, sNIHSS-EMS) consists of 'level of consciousness', 'facial palsy', 'motor arm/leg', 'sensory', 'language' and 'dysarthria'. Sensitivity for stroke recognition of the sNIHSS-EMS is 91% (95% CI 86 to 94), specificity 52% (95% CI 47 to 56). Receiver operating curve analysis revealed an optimal cut-off point for LVO prediction of ≥6 (sensitivity 70% (95% CI 65 to 76), specificity 81% (95% CI 76 to 84), positive predictive value 70 (95% CI 65 to 75), area under

2017 BMJ open PubMed

2. Re-evaluation of the stroke prognostication using age and NIH Stroke Scale index (SPAN-100 index) in IVT patients - the-SPAN 100<sup>65</sup> index. (Full text)

Re-evaluation of the stroke prognostication using age and NIH Stroke Scale index (SPAN-100 index) in IVT patients - the-SPAN 10065 index. The SPAN-100 index adds patient age and baseline NIHSS-score and was introduced to predict clinical outcome after acute ischemic stroke (AIS). Even with high NIHSS-scores younger patients cannot reach a SPAN-100-positive status (index ≥100). We aimed to evaluate the SPAN-100 index among a large, contemporary cohort of i.v.-thrombolysed AIS-patients

2018 BMC Neurology PubMed

3. Innovation in Stroke Care Quality: NIH Stroke Scale Change and Shewhart Charts. (PubMed)

Innovation in Stroke Care Quality: NIH Stroke Scale Change and Shewhart Charts. Stroke care, admission through discharge, is a process that should lead to symptomatic improvement. Improvement or decline in conditions of patients with acute stroke during hospitalization can be measured by the National Institutes of Health Stroke Scale (NIH Stroke Scale or NIHSS) at both admission and discharge and may indicate the overall quality of acute stroke care for a patient and the stability of care (...) in the system. Shewhart control charts were analyzed for 98 patients with stroke admissions in a random sample at a tertiary care stroke center to determine the feasibility of examining the NIHSS score change to detect statistical control or identify excess variance in outcomes. The study sample showed a mean improvement of 1.33 points from admission to discharge on the NIHSS. Three statistical outliers were found. Excess statistical variation clustered within a specific stroke team's tenure suggested

2017 Quality Management in Health Care

4. Abbreviation of the Follow-Up NIH Stroke Scale Using Factor Analysis (Full text)

Abbreviation of the Follow-Up NIH Stroke Scale Using Factor Analysis The NIH Stroke Scale (NIHSS) is a 15-item measure of stroke-related neurologic deficits that, when measured at 24 h, is highly predictive of long-term functional outcome. We hypothesized that a simplified 24-h scale that incorporates the most predictive components of the NIHSS can retain prognostic accuracy and have improved interrater reliability.In a post hoc analysis of the Interventional Management of Stroke-3 (IMS-3 (...) ) trial, we performed principal component (PC) analysis to resolve the 24-h NIHSS into PCs. In the PCs that explained the largest proportions of variance, key variables were identified. Using these key variables, the prognostic accuracies (area under the curve [AUC]) for good outcome (3-month modified Rankin Scale [mRS] 0-2) and poor outcome (mRS 5-6) of various abbreviated NIHSS iterations were compared with the total 24-h NIHSS. The results were validated in the NINDS intravenous tissue plasminogen

2017 Cerebrovascular Diseases Extra PubMed

5. The Utility of Quantifiable Neurologic Assessments After Stroke: In response to Marsh et al, “The NIH Stroke Scale Has Limited Utility in Accurate Daily Monitoring of Neurologic Status” (Full text)

The Utility of Quantifiable Neurologic Assessments After Stroke: In response to Marsh et al, “The NIH Stroke Scale Has Limited Utility in Accurate Daily Monitoring of Neurologic Status” 27366290 2016 07 01 2018 11 13 1941-8744 6 3 2016 Jul The Neurohospitalist Neurohospitalist The Utility of Quantifiable Neurologic Assessments After Stroke: In response to Marsh et al, "The NIH Stroke Scale Has Limited Utility in Accurate Daily Monitoring of Neurologic Status". 95-6 10.1177/1941874416641469 (...) Siegler James E JE Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. eng Journal Article 2016 04 05 United States Neurohospitalist 101558199 1941-8744 National Institutes of Health Stroke Scale outcomes research stroke 2016 7 2 6 0 2016 7 2 6 0 2016 7 2 6 1 ppublish 27366290 10.1177/1941874416641469 10.1177_1941874416641469 PMC4906560 QJM. 2006 Sep;99(9):625-33 16905751 J Stroke Cerebrovasc Dis. 2013 Jul;22(5):675-82 22727922 Int J Stroke. 2015 Feb;10(2):140-2

2016 The Neurohospitalist PubMed

6. Eye-Movement Training Results in Changes in qEEG and NIH Stroke Scale in Subjects Suffering from Acute Middle Cerebral Artery Ischemic Stroke: A Randomized Control Trial. (Full text)

Eye-Movement Training Results in Changes in qEEG and NIH Stroke Scale in Subjects Suffering from Acute Middle Cerebral Artery Ischemic Stroke: A Randomized Control Trial. Eye-movement training (EMT) can induce altered brain activation and change the functionality of saccades with changes of the brain in general.To determine if EMT would result in changes in quantitative electroencephalogram (qEEG) and NIH Stroke Scale (NIHSS) in patients suffering from acute middle cerebral artery (MCA (...) ) infarction. Our hypothesis is that there would be positive changes in qEEG and NIHSS after EMT in patients suffering from acute MCA ischemic stroke.Double-blind randomized controlled trial.Thirty-four subjects with acute MCA ischemic stroke treated at university affiliated hospital intensive care unit.Subjects were randomized into a "control" group treated only with aspirin (125 mg/day) and a "treatment" group treated with aspirin (125 mg/day) and a subject-specific EMT.Delta-alpha ratio, power ratio

2016 Frontiers in neurology PubMed

7. NIH Stroke Scale

NIH Stroke Scale NIH Stroke Scale Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 NIH Stroke Scale NIH Stroke Scale Aka: NIH Stroke (...) Scale II. Precautions NIH Stroke Scale has imperfect interrater reliability (i.e. different scores by different providers) NIH Stroke Scale may be low despite severe, disabling symptoms and signs (e.g. in posterior CVA) Facial droop may be subtle Consider counting visible teeth on each side for comparison When a patient is too weak overall to perform a particular exam element Default to a lower score (as if patient could perform that element) Obviously this does not apply to a focal weakness

2018 FP Notebook

8. Stroke Survivors Scoring Zero on the NIH Stroke Scale Score Still Exhibit Significant Motor Impairment and Functional Limitation. (Full text)

Stroke Survivors Scoring Zero on the NIH Stroke Scale Score Still Exhibit Significant Motor Impairment and Functional Limitation. Objective. To determine the National Institutes of Health Stroke Scale's (NIHSS's) association with upper extremity (UE) impairment and functional outcomes. Design. Secondary, retrospective analysis of randomized controlled trial data. Setting. Not applicable. Participants. 146 subjects with stable, chronic stroke-induced hemiparesis. Intervention. The NIHSS, the UE (...) = 0.089). Subjects scoring a "zero" on the NIHSS exhibited discernible UE motor deficits and varied scores on the UE FM and AMAT. Conclusion. While being used in stroke trials, the NIHSS may have limited ability to discriminate between treatment responses, even when only a relatively narrow array of impairment levels exists among patients. Given these findings, NIHSS use should be restricted to acute stroke studies and clinical settings with the goal of reporting stroke severity.

2014 Stroke research and treatment PubMed

9. The association baseline NIH Stroke Scale score with ABO blood-subtypes in young patients with acute ischemic stroke. (PubMed)

The association baseline NIH Stroke Scale score with ABO blood-subtypes in young patients with acute ischemic stroke. The presence of the A and B blood group antigens has been associated with risk of arterial thrombosis. The aim of the current study was to design a new simpler form of National Institutes of Health Stroke Scale (NIHSS) for use on admission, and assess the association of blood groups with NIHSS score in young stroke patients.We conducted this study in 1311 young Chinese adults (...) with acute ischemic cerebral stroke. The outcome measures included a composite favorable outcome (defined as a modified Rankin Scale (mRS) of 0 or 2) and poor outcome (defined as a modified Rankin Scale score of 3 or 6) at discharge; a minor strokes (NIHSS scores 0-5) and severe strokes (NIHSS scores ≥6). Logistic regression analyses were used to determine the association between ABO blood groups and stroke severity.Regression analysis confirmed in relative to patients with AB subtype, Oxfordshire

2014 Atherosclerosis

10. The NIH Stroke Scale Has Limited Utility in Accurate Daily Monitoring of Neurologic Status (Full text)

The NIH Stroke Scale Has Limited Utility in Accurate Daily Monitoring of Neurologic Status 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

2015 The Neurohospitalist PubMed

11. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement From the American Stroke Association (Full text)

, targeting underserved black communities. To measure improvement in acute treatment rates, large-scale interventions, such as the TLL (Thomas Lewis Latané) Temple Foundation Stroke Project, which was a large community-based grant to improve stroke awareness and treatment in East Texas, or others, are needed to demonstrate the effectiveness of community stroke preparedness interventions. There is a recognized need for a new conceptual model for behavioral theoretical interventions for the prevention (...) . In an Italian study of 18 231 EMS dispatches for stroke-like symptoms, the positive predictive value of the dispatch stroke/TIA symptoms being confirmed on scene by EMS providers was 34.3% (95% CI, 33.7%–35.0%; 6262 of 18 231), and the sensitivity was 64.0% (95% CI, 63.0%–64.9%; 6262 of 9791). Centers that used the Cincinnati Prehospital Stroke Scale (CPSS) more often (ie, >10% of cases) had higher sensitivity (71% [95% CI, 87%–89%] vs 52% [95% CI, 51%–54%]). In a systematic review of prehospital stroke

2019 American Heart Association PubMed

12. The cognitive burden of stroke emerges even with an intact NIH Stroke Scale Score: a cohort study. (PubMed)

The cognitive burden of stroke emerges even with an intact NIH Stroke Scale Score: a cohort study. We aim to facilitate recognition of the cognitive burden of stroke by describing the parallels between cognitive deficits and the National Institutes of Health Stroke Scale (NIHSS), a widely used measure of stroke severity.A consecutive cohort of 223 working-age patients with an acute first-ever ischaemic stroke was assessed neuropsychologically within the first weeks after stroke and at a 6 (...) factors.Cognitive deficits were common even in patients with the lowest NIHSS scores. Thus, low NIHSS scores are not effective indicators of good cognitive outcomes after stroke.

2013 Neurosurgery and Psychiatry

13. Stroke prognostication using age and NIH Stroke Scale: SPAN-100. (Full text)

Stroke prognostication using age and NIH Stroke Scale: SPAN-100. 23918864 2013 10 17 2018 12 02 1526-632X 81 6 2013 Aug 06 Neurology Neurology Stroke prognostication using age and NIH Stroke Scale: SPAN-100. 603 10.1212/01.wnl.0000433418.06773.33 Yufe Robert R eng Letter Comment United States Neurology 0401060 0028-3878 EC 3.4.21.68 Tissue Plasminogen Activator AIM IM Neurology. 2013 Jan 1;80(1):21-8 23175723 Neurology. 2013 Aug 6;81(6):603 24069616 Female Humans Male Severity of Illness Index (...) Stroke diagnosis drug therapy Tissue Plasminogen Activator therapeutic use 2013 8 7 6 0 2013 8 7 6 0 2013 10 18 6 0 ppublish 23918864 81/6/603-a 10.1212/01.wnl.0000433418.06773.33

2013 Neurology PubMed

14. Stroke Prognostication using Age and NIH Stroke Scale: SPAN-100. (Full text)

Stroke Prognostication using Age and NIH Stroke Scale: SPAN-100. Age and stroke severity are major determinants of stroke outcomes, but systematically incorporating these prognosticators in the routine practice of acute ischemic stroke can be challenging. We evaluated the effect of an index combining age and stroke severity on response to IV tissue plasminogen activator (tPA) among patients in the National Institute of Neurological Disorders and Stroke (NINDS) tPA stroke trials.We created (...) the Stroke Prognostication using Age and NIH Stroke Scale (SPAN) index by combining age in years plus NIH Stroke Scale (NIHSS) ≥100. We applied the SPAN-100 index to patients in the NINDS tPA stroke trials (parts I and II) to evaluate its ability to predict clinical response and risk of intracerebral hemorrhage (ICH) after thrombolysis. The main outcome measures included ICH (any type) and a composite favorable outcome (defined as a modified Rankin Scale score of 0 or 1, NIHSS ≤1, Barthel index ≥95

2013 Neurology PubMed

15. CT Angiography and Presentation NIH stroke Scale in Predicting TIA in Patients Presenting with Acute Stroke Symptoms (Full text)

CT Angiography and Presentation NIH stroke Scale in Predicting TIA in Patients Presenting with Acute Stroke Symptoms Patient candidacy for acute stroke intervention, is currently assessed using brain computed tomography angiography (CTA) evidence of significant stenosis/occlusion (SSO) with a high National Institutes of Health Stroke Scale (NIHSS) (>6). This study examined the association between CTA without significant stenosis/occlusion (NSSO) and lower NIHSS (≤ 6) with transient ischemic (...) attack (TIA) and other good clinical outcomes at discharge. Patients presenting <8 hours from stroke symptom onset, had an NIHSS assessment and brain CTA performed at presentation. Good clinical outcomes were defined as: discharge diagnosis of TIA, modified Rankin Score [mRS] ≤ 1, and home as the discharge disposition. Eighty-five patients received both an NIHSS at presentation and a CTA at 4.2 ± 2.2 hours from stroke symptom onset. Patients with NSSO on CTA as well as those with NIHSS≤6 had better

2013 Journal of neurological disorders PubMed

16. Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke

, Liebeskind DS, Starkman S, Eckstein M, Stratton S, Woolf GG, Chatfield F, Conwit R, Saver JL . Field validation of prehospital LAMS score to identify large vessel occlusion ischemic stroke patients for direct routing to emergency neuroendovascular centers [abstract]. Stroke . 2016 ; 47 (suppl 1):83. Cooray C, Fekete K, Mikulik R, Lees KR, Wahlgren N, Ahmed N . Threshold for NIH Stroke Scale in predicting vessel occlusion and functional outcome after stroke thrombolysis. Int J Stroke . 2015 ; 10 :822–829 (...) . Revisiting the NIH Stroke Scale as a screening tool for proximal vessel occlusion: can advanced imaging be targeted in acute stroke [published online ahead of print January 14, 2016]? J Neurointerv Surg . doi: 10.1136/neurintsurg-2015-012088. . Nakajima M, Kimura K, Ogata T, Takada T, Uchino M, Minematsu K . Relationships between angiographic findings and National Institutes of Health Stroke Scale score in cases of hyperacute carotid ischemic stroke. AJNR Am J Neuroradiol . 2004 ; 25 :238–241. Nazliel B

2018 American Heart Association

17. Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke (Full text)

; P=0.05) All-cause mortality at 90 d: 7.8% (6 of 77) vs 20% (17 of 85) (P=0.02) (adjusted OR, 0.33; 95% CI, 0.12–0.90; P=0.03) mRS score =2 at 90 d: 57.1% (44 of 77) vs 57.6% (49 of 85) (P=NS) ASSIST indicates Acute Screening of Swallow in Stroke or TIA [transient ischemic attack]; CI, confidence interval; mRS, modified Rankin Scale; NS, not significant; OR, odds ratio; and RCT, randomized controlled trial. Downloaded from http://ahajournals.org by on March 27, 2019Smith et al Dysphagia Screening (...) Witness Ownership Interest Consultant/ Advisory Board Other Argye E. Hillis Johns Hopkins University NIH (I am mentor on a K23 investigating dysphagia)* None None None None None None Irene L. Katzan Cleveland Clinic Ohio Department of Health (Ohio Coverdell Stroke Quality Improvement Registry)† None None None None None None Walter N. Kernan Yale University None None None None None None None This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived

2018 American Heart Association PubMed

18. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

1 M2 Middle cerebral artery segment 2 M3 Middle cerebral artery segment 3 MCA Middle cerebral artery MI Myocardial infarction MRA Magnetic resonance angiography MRI Magnetic resonance imaging mRS Modified Rankin Scale mTICI Modified Thrombolysis in Cerebral Infarction NCCT Noncontrast computed tomography NIHSS National Institutes of Health Stroke Scale NINDS National Institute of Neurological Disorders and Stroke OR Odds ratio OSA Obstructive sleep apnea RCT Randomized clinical trial RR Relative (...) 1.7. Organization and Integration of Components 1.8. Establishment of Data Repositories 1.9. Stroke System Care Quality Improvement Process 2. Emergency Evaluation and Treatment 2.1. Stroke Scales 2.2. Brain Imaging 2.3. Other Diagnostic Tests 3. General Supportive Care and Emergency Treatment 3.1. Airway, Breathing, and Oxygenation 3.2. Blood Pressure 3.3. Temperature 3.4. Blood Glucose 3.5. IV Alteplase 3.6. Other IV Thrombolytics and Sonothrombolysis 3.7. Mechanical Thrombectomy 3.8. Other EVTs

2018 American Heart Association

19. National Institutes of Health Stroke Scale in Plain English Is Reliable for Novice Nurse Users with Minimal Training. (PubMed)

National Institutes of Health Stroke Scale in Plain English Is Reliable for Novice Nurse Users with Minimal Training. The National Institutes of Health Stroke Scale (NIHSS) is commonly used in Comprehensive Stroke Centers, but it has not been easily implemented in smaller centers. The aim of this study was to assess whether nurse providers who were naive to stroke assessment scales could obtain accurate stroke severity scores using our previously validated NIH Stroke Scale in Plain English (...) (NIHSS-PE) with minimal or no training.We randomly assigned 122 nursing students who were naive to stroke assessment scales to 1 of 4 groups: trained on the NIHSS, untrained on the NIHSS, trained on the NIHSS-PE, or untrained on the NIHSS-PE. The Trained/NIHSS and Trained/NIHSS-PE groups watched assessment scale-specific training DVDs. All 4 study groups scored the same 3 patients from the National Institute of Neurological Disorders and Stroke certification DVD, in randomly assigned order. Two-way

2017 Journal of Emergency Nursing

20. The Evolution of the Modified Rankin Scale and Its Use in Future Stroke Trials (Full text)

The Evolution of the Modified Rankin Scale and Its Use in Future Stroke Trials 28626052 2018 03 09 2019 01 15 1524-4628 48 7 2017 07 Stroke Stroke Evolution of the Modified Rankin Scale and Its Use in Future Stroke Trials. 2007-2012 10.1161/STROKEAHA.117.017866 Broderick Joseph P JP From the Departments of Neurology and Rehabilitation Medicine (J.P.B.) and Emergency Medicine (O.A.), University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati, OH; and Division (...) .), University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati, OH; and Division of Biostatistics, Medical University of South Carolina, Charleston (J.E.). eng U01 NS086872 NS NINDS NIH HHS United States U01 NS087748 NS NINDS NIH HHS United States U10 NS058982 NS NINDS NIH HHS United States Journal Article Research Support, N.I.H., Extramural Review 2017 06 16 United States Stroke 0235266 0039-2499 IM Clinical Trials as Topic Humans Stroke therapy Treatment Outcome clinical trial

2017 Stroke PubMed

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