NIHSS scores across a population: Sampling our collective stroke “health”
Peter Hannon, MD
We all perform an NIHSS to quickly assess an acute stroke patient’s status, but what if we could utilize this score as a means to assess the stroke health of a community? Reeves and colleagues have investigated doing just this by collecting retrospective NIHSS scores from ischemic stroke patients within the Cincinnati/Northern Kentucky Stroke Study for one calendar year.
In 2005, ischemic strokes were screened at 17 hospitals, as well as at hospital-based ERs and outpatient clinics, public health clinics, and via a sampling scheme, at 51 of 832 physician offices and 25 of 126 nursing homes. A total of 2233 ischemic strokes were identified, and a retrospective NIHSS (rNIHSS) was performed based on physical findings at the initial examination. rNIHSS distribution was stratified by age, sex, race and location of ascertainment. The median scores were found to be higher for in-hospital strokes (7), lowest for out-of-hospital strokes (1), and right at the overall median for cases admitted to the hospital (3). Patients over 80 had higher scores than those younger (4 vs. 3), but there were no significant differences by sex or race. Surprisingly, >50% had mild symptoms severity at presentation (rNIHSS <3), which the authors note is in general agreement with other reports that have presented NIHSS data from population or community-based studies. While this study has some limitations, such as having to retrospectively assess NIH Stroke Scales, it does raise the interesting concept of being able to utilize a collective NIHSS to track trends in a community’s stroke “health” as efforts continue in outreach, education and stroke prevention. If this information was continuously collected and readily accessible, what could it tell us about a community’s health over time?
We all perform an NIHSS to quickly assess an acute stroke patient’s status, but what if we could utilize this score as a means to assess the stroke health of a community? Reeves and colleagues have investigated doing just this by collecting retrospective NIHSS scores from ischemic stroke patients within the Cincinnati/Northern Kentucky Stroke Study for one calendar year.
In 2005, ischemic strokes were screened at 17 hospitals, as well as at hospital-based ERs and outpatient clinics, public health clinics, and via a sampling scheme, at 51 of 832 physician offices and 25 of 126 nursing homes. A total of 2233 ischemic strokes were identified, and a retrospective NIHSS (rNIHSS) was performed based on physical findings at the initial examination. rNIHSS distribution was stratified by age, sex, race and location of ascertainment. The median scores were found to be higher for in-hospital strokes (7), lowest for out-of-hospital strokes (1), and right at the overall median for cases admitted to the hospital (3). Patients over 80 had higher scores than those younger (4 vs. 3), but there were no significant differences by sex or race. Surprisingly, >50% had mild symptoms severity at presentation (rNIHSS <3), which the authors note is in general agreement with other reports that have presented NIHSS data from population or community-based studies. While this study has some limitations, such as having to retrospectively assess NIH Stroke Scales, it does raise the interesting concept of being able to utilize a collective NIHSS to track trends in a community’s stroke “health” as efforts continue in outreach, education and stroke prevention. If this information was continuously collected and readily accessible, what could it tell us about a community’s health over time?
