Comparison of the NIH Stroke Scale and the Modified NIH Stroke Scale by Classification and Location of Cerebral Infarction

J Korean Neurol Assoc > Volume 24(2); 2006 > Article

Journal of the Korean Neurological Association 2006;24(2): 112-116.

허혈성 뇌졸중의 아형 및 병변 위치에 따른 NIH Stroke Scale과 개량형 NIH Stroke Scale의 비교

부선희, 윤성상 장혜정a 권영대b 박기정 안태범 장대일 정경천

경희대학교 의과대학 신경과학교실, 경희대학교 경영대학 의료경영학전공a, 성균관대학교 의과대학 사회의학교실b

Comparison of the NIH Stroke Scale and the Modified NIH Stroke Scale by Classification and Location of Cerebral Infarction

Seon Hee Bu, M.D.

Department of Neurology, Kyung Hee University College of Medicine, Seoul; Department of Health Services Management, Kyung Hee University College of Business Administrationa, Seoul; Department of Social & Preventive Medicine, Sungkyunkwan University School of Medicineb, Seoul, Korea

Abstract

Background: The National Institutes of Health Stroke Scale (NIHSS) is regarded as a valid and reliable tool to measure the severity of neurological deficits in acute stroke, but has been criticized for its complexity and variability. Therefore, the modified NIHSS (mNIHSS) was developed, eliminating redundant and less reliable items from the full version of the NIHSS. The aim of the present study was to evaluate the validity of the mNIHSS according to the subtypes of stroke and the location of affected arterial territories.
Methods: The severity of stroke in 155 patients with acute cerebral infarction was measured. Each patient was evaluated by two neurologists using both the NIHSS and mNIHSS, and the stroke subtype was determined according to the TOAST classification. The vascular territory of lesion was classified into an anterior and posterior circulation. The criterion-related validity was evaluated by the Pearson Correlation Coefficient between the NIHSS and mNIHSS scores.
Results: When considering the NIHSS scores as the gold criteria, the Pearson correlation coefficients of the mNIHSS were 0.96 in the subtype of large artery atherosclerosis, 0.91 in small vessel occlusion, 0.98 in cardioembolism, and 0.99 in undetermined etiology. On the other hand, the correlation coefficient was 0.98 in patients with an anterior circulation infarction, and was 0.94 in patients with a posterior circulation infarction.
Conclusions: The criterion-related validity of the mNIHSS scoring system was very high in general. However, the correlations were relatively low in patients with the TOAST subtype of small vessel occlusion and also a posterior circulation infarction.KeyWords:Cerebral infarction, Outcome, Stroke assessment