We collapsed some items, and made some items easier to score, and the data show that it’s clearly more reproducible than the original. The modified NIHSS is more reproducible than the original. It’s not inherently better than any other scale, but it’s used, and everybody knows it. So there are over 800,000 people worldwide who have been certified with those videos.
#ANTI STROKE MEDS CLASS TRIAL#
And since the tPA trial was the first positive stroke study, everybody started using the NIHSS. It was adopted because it happened to be the scale that was used in the tPA trial. But the NIHSS is the most widely used, because of its use in the tPA trial, and there are training videos available. There’s only so many ways to put numbers on the neuro exam. How does the NIHSS compare to other stroke assessments?Īt the time the NIHSS was developed, there were a dozen other scales, and they’re all roughly the same. tPA should be used regardless of severity. Higher stroke scale scores indicate higher severity and poorer prognosis, but the stroke scale is NOT a guide to picking patients for tPA. What recommendations do you have for health care providers once they have applied the NIH stroke scale?
#ANTI STROKE MEDS CLASS HOW TO#
The stroke scale has grown so far beyond its original purpose, which is fine, but you have to understand where it came from and how to use it correctly. The government is now looking at outcomes based on stroke severity, so all of a sudden, this scale that we invented for research has become essential for hospitals to get reimbursed, because the more severe the stroke is, the more the reimbursement. The scoring rules are there to assure reproducibility, across users of all different backgrounds, whether it’s a neuro nurse, a neurologist, or an ED physician. Neurologists think they’re smarter than the scale, so they don’t follow the scoring rules. ED physicians do the best, because they follow the rules. It’s not true that you have to be a neurologist in order to use the NIHSS. A lot of the scoring rules are counterintuitive if you’re a good neurologist. This is fundamental and important for users to keep in mind. The point of the NIHSS is to rate groups of patients, not individuals. What pearls, pitfalls and/or tips do you have for users of the NIH stroke scale? Are there cases in which it has been applied, interpreted, or used inappropriately? The NIH stroke scale was developed for use in the NINDS tPA trial. Why did you develop the NIH stroke scale?