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Modified NIH Stroke Scale/Score (mNIHSS)

Calculators  Neurology
The mNIHSS may help physicians to determine the severity of a stroke and predict the clinical outcomes. The mNIHSS has the same correlation as the NIHSS but with improved interrater reliability.
Level of consciousness/orientation questions
Both questions correct 0
1 question correct 1
0 questions correct 2
Level of consciousness commands
Blink eyes' & 'squeeze hands' (pantomime commands if communication barrier)
Both tasks correct 0
1 task correct 1
0 tasks correct 2
Test horizontal extra-ocular movements
Normal 0
Partial gaze palsy 1
Total gaze palsy 2
Test visual fields
No visual loss 0
Partial hemianopia 1
Complete hemianopia 2
Bilateral hemianopia 3
Test left arm motor drift
No drift 0
Drift before 10 seconds 1
Falls before 10 seconds 2
No effort against gravity 3
No movement 4
Test right arm motor drift
No drift 0
Drift before 10 seconds 1
Falls before 10 seconds 2
No effort against gravity 3
No movement 4
Test left leg motor drift
No drift 0
Drift before 5 seconds 1
Falls before 5 seconds 2
No effort against gravity 3
No movement 4
Test right leg motor drift
No drift 0
Drift before 5 seconds 1
Falls before 5 seconds 2
No effort against gravity 3
No movement 4
Sensation testing
Normal; no sensory loss 0
Abnormal; sensory loss 1
Test language/aphasia
Describe the scene; name the items; read the sentences (see Evidence)
Normal; no aphasia 0
Mild aphasia 1
Severe aphasia 2
Mute/global aphasia 3
Test extinction/inattention/neglect
Normal 0
Mild 1
Severe 2
Result:

Background

Measured Factor
Modified NIHSS score
Measured Factor Disease
  • Severity of Stroke
Measured Factor Detail
The mNIHSS may help physicians to determine the severity of a stroke and predict clinical outcomes which may help guide management.
Speciality
Neurologist
Body System
Neurology

Result Interpretation

Ranges Ranges
  • Normal: 0
Test Limitations
mNIHSS failed to accurately or reliably detect patients with posterior circulation findings
References: 2

Studies

Study Validation 1
The aim of this prospectively study was to validate the modified version of The National Institutes of Health Stroke Scale (mNIHSS) in patients with stroke.  A total 45 patients with stroke were recruited in the study from 2000 to 2001. Patients were evaluated by both NIHSS and mNIHSS scales. Results showed that 10 (90.91%) of 11 mNIHSS kappa scores had a excellent agreement while only 10 (66.67%) of 15 NIHSS kappa scores showed excellent promise. The validity of mNHSS was confirmed by use of correlation coefficient analysis. This study concluded that as mNIHSS scale had much higher kappa values compared to older NIHSS scale it is more accurate to use clinically in predicting stroke severity in patients.
References: 3
Study Validation 2
The purpose of this study was to estimate the accuracy of mNIHSS from a previous study conducted on NIHSS score in 39 patients. NIHSS scores were calculated by 5 raters blinded to actual scores and medical records were also evaluated. Results showed that mNIHSS had greater correlation coefficients (ICCs) of 0.87 and 0.89 on admission and discharge, respectively compared to ICCs of NIHSS scale with 0.85 and 0.79, respectively. No case had shown poor reliability in mNIHSS group confirming its further accuracy. The study concluded that mNIHSS had a better performance than previous NIHSS scale and may be more convenient to use.
References: 4
Study Additional 1
The aim of the study was to compare the performance of The National Institutes of Health Stroke Scale (NIHSS) and modified NIHSS. Standard NIHSS score and many items with poor reliability and redundancy so to improve the accuracy of the scale certain items were removed in mNIHSS scale. Reliability was greater with mNIHSS scale in multiple settings and cohorts clinical trial. In case of NIHSS the the number of elements with excellent agreement was 54% which was increased to 71% in case mNIHSS. This study concluded that mNIHSS with much simpler items is better predictor than the standard NIHSS scale allowing refinement of trial enrollments.
References: 2

References

  1. Lyden PD, Lu M, Levine SR, Brott TG, Broderick J. A modified National Institutes of Health Stroke Scale for use in stroke clinical trials: preliminary reliability and validity. Stroke. 2001;32(6):1310-7.
  2. Meyer BC, Lyden PD. The modified National Institutes of Health Stroke Scale: its time has come. Int J Stroke. 2009;4(4):267-73.
  3. Meyer BC, Hemmen TM, Jackson CM, Lyden PD. Modified National Institutes of Health Stroke Scale for use in stroke clinical trials: prospective reliability and validity. Stroke. 2002;33(5):1261-6.
  4. Kasner SE, Cucchiara BL, Mcgarvey ML, Luciano JM, Liebeskind DS, Chalela JA. Modified National Institutes of Health Stroke Scale can be estimated from medical records. Stroke. 2003;34(2):568-70.