NIHSS Score Sheet
Unlock the significance of NIHSS scores in stroke assessment. Explore our guide for insights on severity, prognosis, and treatment decisions.
Fact Checked by Ericka Pingol.
What is the NIH stroke scale?
The NIH Stroke Scale (NIHSS) is a clinical assessment tool designed to objectively quantify the severity of stroke-related neurological deficits. Developed by the National Institute of Neurological Disorders and Stroke (NINDS) and first introduced in 1989, the NIHSS has become a widely accepted instrument for evaluating and documenting the neurological status of stroke patients.
The scale comprises 11 components, each assessing different aspects of neurological function. These components include level of consciousness, eye movement, visual fields, facial palsy, motor strength in the arms and legs, coordination, and language skills. Each component is assigned a score based on the observed impairment, ranging from 0 (normal function) to 4 or 5 (severe impairment). The total NIHSS score is obtained by summing these individual component scores, with higher scores indicating more severe neurological deficits.
The primary goal of the NIHSS is to provide a standardized and reproducible method for clinicians to assess and communicate the severity of stroke-related impairments. It is typically administered by trained healthcare professionals, often neurologists or stroke team members, during the initial evaluation of a patient with acute stroke symptoms.
The NIHSS plays a crucial role in several aspects of stroke care. Firstly, it aids in triaging and identifying patients who may benefit from acute interventions such as thrombolytic therapy or endovascular procedures. Patients with higher NIHSS scores are more likely to have severe strokes and may be candidates for more aggressive treatment approaches.
The NIH stroke scale facilitates communication among healthcare providers by offering a standardized language for describing neurological deficits. This is particularly important in coordinating care within stroke teams and when communicating with other healthcare professionals involved in the patient's treatment.
This health stroke scale assesses and monitors changes in a patient's neurological status over time. Serial assessments can help clinicians evaluate the effectiveness of interventions, track the natural course of recovery, and guide ongoing treatment decisions.
While the NIHSS is a valuable tool in acute stroke management, it has limitations. The scale may not capture certain aspects of stroke-related impairments, and its application may be influenced by factors such as patient cooperation and the examiner's experience. Despite these limitations, the NIHSS remains a key instrument in the comprehensive evaluation of acute stroke patients, contributing to improved and standardized stroke care.
Printable NIHSS Score Sheet
Download this NIHSS Score Sheet to quantify the severity of stroke-related neurological deficits.
Signs and symptoms of a stroke
A stroke is a medical emergency that occurs when there is a sudden disruption of blood flow to the brain, leading to damaged brain cells. The signs and symptoms of a stroke can vary depending on the type of stroke (ischemic or hemorrhagic) and the area of the brain affected. Recognizing these symptoms and seeking immediate medical attention is important, as early intervention can significantly improve outcomes. Common signs and symptoms of a stroke include:
Sudden numbness or weakness
One side of the face, arm, or leg may suddenly become numb or weak. This often occurs on just one side of the body.
Confusion or trouble speaking
A person experiencing a stroke may have difficulty speaking or understanding speech. Speech may be slurred, and the person may struggle to find the right words.
Trouble walking or loss of balance
Sudden dizziness, loss of coordination, or difficulty walking can be indicative of a stroke. The person may struggle to maintain balance and coordination.
Sudden severe headache
A sudden and severe headache, often described as the worst headache of one's life, can be a symptom of a hemorrhagic stroke. This is because severe stroke is more common in cases of bleeding within the brain.
Trouble seeing in one or both eyes
Vision problems, such as sudden blurred or blackened vision in one or both eyes, can occur during a stroke. Double vision may also be a symptom.
Difficulty swallowing
Some individuals may experience difficulty swallowing or may suddenly choke while eating or drinking.
Immediate medical attention is essential for stroke patients. The use of clot-busting medications and other interventions is most effective when administered within a few hours of the onset of symptoms. If you suspect someone is having a stroke, don't delay – call for emergency help right away.
When should the NIH stroke scale be used?
The NIH Stroke Scale (NIHSS) is a clinical assessment tool specifically designed for use in evaluating and quantifying neurological deficits in individuals with suspected or confirmed stroke. Healthcare professionals, particularly those in acute stroke care, use the NIHSS in various clinical scenarios. Here are some key situations when the NIH Stroke Scale should be employed:
Acute stroke evaluation
The NIHSS is typically used during the initial assessment of individuals presenting with symptoms suggestive of acute stroke. This includes sudden onset of focal neurological deficits such as weakness, numbness, speech difficulties, or visual disturbances.
Emergency department triage
In the emergency department, the NIHSS assists healthcare providers in quickly assessing the severity of stroke-related impairments. This information is crucial for determining the urgency of diagnostic imaging (such as a CT scan) and initiating appropriate interventions.
Treatment decision-making
The NIHSS plays a significant role in guiding treatment decisions, especially when considering the use of thrombolytic therapy (such as alteplase) or endovascular interventions for ischemic strokes. The severity of neurological deficits, as measured by the NIHSS, can influence the risk-benefit assessment for these time-sensitive treatments.
Monitoring stroke progression
The NIHSS is employed to assess and monitor changes in a patient's neurological status over time. Serial assessments can help healthcare providers track the natural course of recovery or identify signs of worsening neurological function.
Clinical research
The NIHSS is often utilized in clinical research studies focused on stroke outcomes, treatment effectiveness, and other related areas. Standardized assessments using the NIHSS contribute to consistency and comparability across different research settings.
Rehabilitation planning
The NIHSS may be used to guide rehabilitation planning by providing a baseline assessment of the severity of neurological deficits. This information helps determine appropriate rehabilitation interventions and set realistic recovery goals.
Communication among healthcare providers
The NIHSS provides a standardized language for communicating the extent of neurological impairment among healthcare team members, including neurologists, emergency physicians, and stroke care specialists.
It's important to note that the NIHSS is specifically tailored for use in the context of acute stroke treatment. While it is valuable for assessing and communicating neurological deficits in this population, other assessment tools may be more appropriate for different neurological conditions. In summary, the NIHSS is an integral component of acute stroke care and is utilized to guide decision-making and optimize patient outcomes.
Areas of assessment
The NIH Stroke Scale (NIHSS) is a comprehensive tool designed to assess various domains of neurological function. It consists of 11 components, each focusing on specific areas of assessment.
These components provide a standardized and quantitative evaluation of stroke-related deficits. Here are the areas of assessment covered by the NIH Stroke Scale:
- Level of consciousness (LOC): This assesses the patient's level of alertness and responsiveness. It includes questions about the patient's orientation to time, place, and person.
- Orientation questions: The patient is asked about the current month and their age to assess orientation to time and person.
- Response to commands: The ability to follow simple commands, such as opening and closing the eyes or squeezing the examiner's hand, is evaluated.
- Best gaze: This component assesses horizontal eye movement by checking for gaze deviation, particularly in response to stimulus or commands.
- Visual fields: The patient's ability to see in different visual fields is evaluated by assessing their ability to track moving objects in each hemifield.
- Facial palsy: This assesses facial muscle strength and symmetry by observing the patient's ability to smile, show teeth, and raise eyebrows.
- Motor arm: The strength and coordination of both arms are assessed by having the patient lift and hold their arms parallel to the ground.
- Motor leg: Similar to the motor arm component, the strength and coordination of both legs are assessed by having the patient lift and hold their legs parallel to the ground.
- Limb ataxia: The patient's coordination is evaluated by assessing for signs of limb ataxia, such as irregular or unsteady movements.
- Sensory: The patient's ability to feel light touch is assessed in different areas of the body to identify sensory deficits.
- Language: Language function is evaluated by asking the patient to name objects, repeat specific phrases, and follow verbal commands.
These components cover a range of neurological functions, including motor strength, coordination, sensory perception, and language abilities. The NIHSS is structured to provide a detailed and standardized assessment of stroke-related impairments, helping healthcare professionals determine the severity of neurological deficits and guide treatment decisions.
NIHSS Score Sheet example (sample)
Eager to utilize this essential stroke care tool? Acquire a free, downloadable, and printable NIHSS Template PDF with fictional data to help you confidently track your patient's needs or act as an educational tool.
Our crafted sample template is designed to assist you in efficiently utilizing the chart and evaluating the goals of care for patients who have had a stroke. It includes dedicated sections for evaluation, interventions, and symptom tracking.
Secure your copy by either previewing the sample below or clicking the "Download Example PDF" button.
Carepatron offers a suite of resources and guides specific to stroke survivors' care, a few of which are linked below to help you and your practice:
Download this free NIHSS Score Sheet example here:
Research and evidence
The NIH Stroke Scales boast a robust history founded on extensive research, affirming their pivotal role in stroke assessment and management. Developed by the National Institute of Neurological Disorders and Stroke (NINDS) to address the need for a standardized stroke severity assessment tool, these scales were introduced in the early 1980s and have gained widespread acceptance in evaluating stroke patients. Collaborating with stroke experts, neurologists, and healthcare professionals, the development process yielded a comprehensive assessment tool.
The scales' adoption is firmly rooted in substantial research and clinical evidence, affirming their validity and reliability. Numerous studies have demonstrated their accuracy in quantifying stroke severity and predicting patient outcomes, with strong interrater reliability observed across diverse healthcare professionals assessing the same patient.
Research has underscored the scales' utility in guiding treatment decisions. Higher NIHSS scores have been linked to increased mortality risk and poorer functional outcomes, assisting physicians in determining appropriate interventions for stroke patients.
The scales' significance extends to clinical research, serving as an objective measure for assessing treatment effects in trials. The standardized scoring system ensures reliable comparison and analysis of data across different studies.
Developed over decades with continuous input from medical experts and researchers, the NIH Stroke Scales have become integral to stroke assessment, treatment planning, and research advancement. Their widespread adoption, extensive research validation, and seamless integration into clinical practice underscore their indispensable role in the realm of stroke care.
Why use Carepatron as your neurology software?
Selecting Carepatron as your preferred application for creating Stroke Scale Charts offers numerous advantages for healthcare practitioners.
Carepatron provides a centralized workspace, allowing you to manage clinical documents and electronic patient records, set patient appointment reminders, and handle medical billing seamlessly and efficiently within the platform, eliminating the need for additional software downloads. This integrated and comprehensive approach simplifies and streamlines processes and tasks related to stroke management, care, and various other activities, giving you peace of mind and allowing you to focus most of your time, attention, and effort on patient care.
Carepatron is dedicated to offering a highly efficient and productive platform for thousands of healthcare professionals, allowing you to customize tools and workflows to meet your unique needs. Additionally, it empowers practitioners and patients to manage administrative tasks such as service booking and completing paperwork. The easy sharing of essential documents and data through the app ensures a top-quality customer experience.
We strongly believe in providing radical accessibility, making our app available on any device you have at your disposal. Our portable medical dictation software simplifies clinical note-making and updates, ensuring an effortless process. With great accessibility comes great responsibility, and we prioritize the security of all notes, clinical records, results, and practitioner data by complying with global security requirements, including HIPAA, GDPR, and HITRUST.
References
Health professionals. (n.d.). National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/public-education/know-stroke/health-professionals
Hoffman, H. (2022). What Is The NIH Stroke Scale (NIHSS)? Saebo. https://www.saebo.com/blog/nih-stroke-scale-nihss/
Lyden, P. D. (2017). Using the National Institutes of Health Stroke scale. Stroke, 48(2), 513–519. https://doi.org/10.1161/strokeaha.116.015434
NIH Stroke scale. (n.d.-a). National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/public-education/know-stroke/health-professionals/nih-stroke-scale
NIH Stroke scale. (n.d.-b). Physiopedia. https://www.physio-pedia.com/NIH_Stroke_Scale
NIH Stroke Scale/Score (NIHSS). (n.d.). https://reference.medscape.com/calculator/273/nih-stroke-scale-score-nihss
Commonly asked questions
The NIHSS is specifically designed to assess and quantify the severity of neurological deficits in individuals with suspected or confirmed stroke. Unlike general neurological assessment tools, the NIHSS focuses on stroke-related deficits, providing a standardized and quantitative evaluation. It is particularly tailored for acute stroke care and is widely used in the context of thrombolytic therapy and endovascular interventions.
The NIHSS is usually administered during the initial assessment of individuals presenting with symptoms suggestive of acute stroke. Trained healthcare professionals, including neurologists, emergency physicians, stroke team members, and other qualified personnel, typically perform the NIHSS.
The NIHSS score plays a significant role in guiding treatment decisions, especially concerning thrombolytic therapy (such as alteplase) and endovascular interventions for ischemic strokes. Higher NIHSS scores may indicate more severe strokes, making patients potential candidates for more aggressive and time-sensitive interventions.
