Shortened NIHSS for Rapid Stroke Assessment in Emergency Care Settings

Sama Rahnemayan; Alireza Ala; Nasrin Taghizadeh; Elyar Sadeghi-Hokmabadi; Ipak Entezari; Samad Shamsvahdati

doi:10.1097/NRL.0000000000000608

Shortened NIHSS for Rapid Stroke Assessment in Emergency Care Settings

Neurologist. 2024 Dec 18. doi: 10.1097/NRL.0000000000000608. Online ahead of print.

Authors

Sama Rahnemayan¹, Alireza Ala², Nasrin Taghizadeh², Elyar Sadeghi-Hokmabadi¹, Ipak Entezari², Samad Shamsvahdati²

Affiliations

¹ Neuroscience Research Center (NSRC), Tabriz University of Medical Sciences.
² Emergency Medicine Department, Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran.

PMID: 39722575
DOI: 10.1097/NRL.0000000000000608

Abstract

Objectives: The National Institutes of Health Stroke Scale (NIHSS) is widely used to assess ischemic stroke severity, but its full 11-item version can be time-consuming. This study evaluates the NIHSS-8, a shortened version, for its efficacy compared with NIHSS-11 in an emergency department setting.

Methods: A cohort study was conducted from May 2018 to May 2019 at Imam Reza Hospital, Tabriz, Iran. Patients with suspected acute stroke were assessed using both NIHSS-11 and NIHSS-8. The modified Rankin Scale (mRS) was used to evaluate patient outcomes at discharge. Correlations between NIHSS-8, NIHSS-11, and mRS were analyzed, and diagnostic performance metrics were calculated.

Results: The study included 292 patients with a mean age of 70.40 years. Approximately 68.5% of patients were categorized as having moderate stroke severity using NIHSS-11, with a similar 67.1% using NIHSS-8. The correlation between NIHSS-11 and NIHSS-8 scores was high (intraclass correlation coefficient of 0.970). Both scales showed strong relationships with mRS at discharge but were not significantly correlated with long-term outcomes. NIHSS-8 demonstrated a sensitivity of 97.5% and specificity of 96.9%, while NIHSS-11 showed 100% sensitivity and 96.9% specificity.

Conclusions: NIHSS-8 is a reliable and efficient alternative to NIHSS-11 for assessing stroke severity in emergency departments. It provides high sensitivity and specificity while being less time-consuming, making it suitable for rapid stroke assessment and triage.