NIH Stroke Scale

NIHSS English (click here)

The International Network

The NIH Stroke Scale (NIHSS) International is an initiative by national and international government entities as well as private and scholastic organizations. These bodies are dedicated to promoting wellness and better patient care in the field of stroke.
It is our vision to provide all patients the best opportunity for survival. We believe the “Know Stroke” program gives healthcare providers the necessary tools to obtain this objective.

Mission

To modernize the global healthcare and clinical research system using global standards of care so that no patient is left behind, no matter what race, religion, socio-economic status, political affiliation or geographical location.

Approach to Human Subject Protection and Patient Safety

"The National Institutes of Health Stroke Scale (NIHSS) is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit. The NIHSS was originally designed as a research tool to measure baseline data on patients in acute stroke clinical trials. Now, the scale is also widely used as a clinical assessment tool to evaluate acuity of stroke patients, determine appropriate treatment, and predict patient outcome. The NIHSS can be used as a clinical stroke assessment tool to evaluate and document neurological status in acute stroke patients. The stroke scale is valid for predicting lesion size and can serve as a measure of stroke severity. The NIHSS has been shown to be a predictor of both short and long term outcome of stroke patients. Additionally, the stroke scale serves as a data collection tool for planning patient care and provides a common language for information exchanges among healthcare providers. The scale is designed to be a simple, valid, and reliable tool that can be administered at the bedside consistently by physicians, nurses or therapists."
"The NIHSS is a 15-item neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss. A trained observer rates the patent’s ability to answer questions and perform activities. Ratings for each item are scored with 3 to 5 grades with 0 as normal, and there is an allowance for untestable items. The single patient assessment requires less than 10 minutes to complete. The evaluation of stroke severity depends upon the ability of the observer to accurately and consistently assess the patient."

Modified Rankin Scale International

A consistent approach to scoring patient recovery is essential for healthcare and research purposes and is desirable for routine clinical application. This training program was prepared by Professor KR Lees in association with the Media Services Department of the University of Glasgow, with the assistance of an educational grant. The support and co-operation of staff in the Acute Stroke Unit Cerebrovascular Clinic of the Western Infirmary, Glasgow and of Drumchapel Hospital, Glasgow is gratefully acknowledged. Patients shown in the recordings gave consent to use of this material for teaching and research purposes. Unauthorised copying, sale or distribution of the material is prohibited. Patients shown in the recordings gave consent to use of this material for teaching and research purposes. Unauthorised copying, sale or distribution of the material is prohibited.

Barthel Index

This index measures the extent to which somebody can function independently and has mobility in their activities of daily living (ADL) i.e. feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation and stair climbing. The index also indicates the need for assistance in care. The Barthel Index (BI) is a widely used measure of functional disability. The index was developed for use in rehabilitation patients with stroke and other neuromuscular or musculoskeletal disorders, but may also be used for oncology patients.

Fugl-Meyer Assessment (FMA) (coming soon)

The Fugl-Meyer Assessment (FMA) is a stroke-specific, performance-based impairment index. It is designed to assess motor functioning, balance, sensation and joint functioning in patients with post-stroke hemiplegia (Fugl-Meyer, Jaasko, Leyman, Olsson, & Steglind, 1975; Gladstone, Danells, & Black, 2002). It is applied clinically and in research to determine disease severity, describe motor recovery, and to plan and assess treatment.

Columbia-Suicide Severity Rating Scale (C-SSRS)

The C-SSRS is used extensively across primary care, clinical practice, surveillance, research, and institutional settings. It is available in over 100 country-specific languages, and is part of a national and international public health initiative involving the assessment of suicidality, including general medical and psychiatric emergency departments, hospital systems, managed care organizations, behavioral health organizations, medical homes, community mental health agencies, primary care, clergy, hospices, schools, college campuses, US Army, National Guard, VAs, Navy and Air Force settings, frontline responders (police, fire department, EMTs), substance abuse treatment centers, prisons, jails, juvenile justice systems, and judges to reduce unnecessary hospitalizations. Of note, the CDC adopted the Columbia definitions (referenced in CDC document) and there is a link to the C-SSRS in the new CDC surveillance document.

Beck Depression Inventory® (BDI)

The Beck Depression Inventory (BDI) is a 21-item, self-report rating inventory that measures characteristic attitudes and symptoms of depression (Beck, et al., 1961). The BDI has been developed in different forms, including several computerized forms, a card form (May, Urquhart, Tarran, 1969, cited in Groth-Marnat, 1990), the 13-item short form and the more recent BDI-11 by Beck, Steer & Brown, 1996. (See Steer, Rissmiller & Beck , 2000 for information on the clinical utility of the BDI-11.) The BDI takes approximately 10 minutes to complete, although clients require a fifth – sixth grade reading level to adequately understand the questions (Groth-Marnat, 1990). Internal consistency for the BDI ranges from .73 to .92 with a mean of .86. (Beck, Steer, & Garbin, 1988). Similar reliabilities have been found for the 13-item short form (Groth-Marnat, 1990). The BDI demonstrates high internal consistency, with alpha coefficients of .86 and .81 for psychiatric and non-psychiatric populations respectively (Beck et al., 1988). References Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571. Beck, A. T., Steer, R.A., & Garbin, M.G. (1988) Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77-100. Groth-Marnat G. (1990). The handbook of psychological assessment (2nd ed.). New York: John Wiley & Sons. Hojat, M., Shapurian, R., Mehrya, A.H., (1986). Psychometric properties of a Persian version of the short form of the Beck Depression Inventory for Iranian college students, Psychological Reports, 59(1), 331-338. Steer, R. A., Rissmiller, D. J.& Beck, A.T., (2000) Use of the Beck Depression Inventory with depressed geriatric patients. Behaviour Research and Therapy, 38(3), 311-318.

CDISC Standards

Analysis Data Model (ADaM)
ADaM defines dataset and metadata standards that support: efficient generation, replication, and review of clinical trial statistical analyses, and traceability between analysis results, analysis data, and data represented in the Study Data Tabulation Model (SDTM).

BRIDG
The BRIDG Model is a Domain Analysis Model (DAM) that is being developed through a collaborative effort of stakeholders from CDISC, the HL7 Regulated Clinical Research Information Management Technical Committee (RCRIM TC), the National Cancer Institute (NCI), and the US Food and Drug Administration (FDA).

Clinical Data Acquisition Standards Harmonization (CDASH)
Developed with participation from organizations in all three ICH (International Conference on Harmonization) regions (US, Europe and Japan), CDASH v1.1 describes the recommended data collection fields for 16 domains, including demographics, adverse events, and other domains common to most therapeutic areas and clinical research phases. Additionally, CDASH v1.1 includes implementation guidelines, best practice recommendations, regulatory references.

Study Data Tabulation Model (SDTM)
SDTM provides a standard for organizing and formatting data to streamline processes in collection, management, analysis and reporting. Implementing SDTM supports data aggregation and warehousing; fosters mining and reuse; facilitates sharing; helps perform due diligence and other important data review activities; and improves the regulatory review and approval process. SDTM is also used in non-clinical data (SEND), medical devices and pharmacogenomics/genetics studies.

Important Quotes from Industry Leaders

“Working closely with global industry leaders– including major universities, governments, private and not-for profit organizations–we have proven that we can ultimately create globally accepted standards without boundaries, moving our industry to become more efficient by breaking down the silos and non-collaborative models,” said Al O. Pacino, President, HealthCarePoint. “Our collaborative approach eliminates redundant burdens at the investigator site level, saving industry stakeholders billions, as regulatory agencies continue to require increased proof of competencies and professional compliance.”

When NINDS produced a full and accurate, high quality program for the NIH Stroke Scale in 2002, we knew it was something the research community badly needed. But I don’t think we could have ever dreamed that the program would reach this many people. We are impressed by the fact that this important medical tool has been made available globally, and to so many disciplines,” said Walter J. Koroshetz, M.D., Deputy Director of the National Institute of Neurological Disorders and Stroke at the National Institutes of Health.

“As the most successful training and certification program, the NIHSS International illustrates how other programs can achieve global acceptance. By combining programs like the NIHSS into global healthcare and clinical research, we could ultimately improve outcomes as all healthcare providers learn to diagnose patients the same way–in a standardized fashion.”–Patrick Lyden, MD, FAAN, FAHA, Chairman, Department of Neurology Carmen and Louis Warschaw Chairin Neurology Cedars-SinaiMedical Center.

“The Portuguese language is spoken by 244 million people worldwide. The NIHSS certification has become a vastly important initiative, allowing healthcare providers to transnationally use the instrument as a standard of care, ultimately leading to better outcomes for stroke patients.”–Elsa Azevedo, MD, PhD, São João Hospital Center, University of Porto, Portugal; Pedro Castro, MD, São João Hospital Center, University of Porto.

"The NIHSS is used widely In the Netherlands during trials. Now we have the opportunity to promote its use in routine care by certified ER personnel, stroke nurses and neurologists, and I am convinced that this will improve the care and clinical outcomes of our stroke patients.”–Diederik W J Dippel, MD, Prof, Erasmus MC University Medical Center.

“Spanish is spoken by nearly 406 million people in 31 countries. Not only has the Spanish-NIHSS become widely used across most of the Spanish-speaking world, it has also become a unifying tool for research, stroke registers, quality control and every day clinical work. We are very proud of being a part of this global effort.”–Arnold Hoppe, MD, Director Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiagode Chile.

“When the Italian-NIHSS became public, we thought we would be helping Italian stroke physicians and nurses to improve their ability to use the scale in the proper way. Over the years, we came to realize that NIHSS is not only a scale, it now belongs to a new vision of modern stroke care!”–Francesca Romana Pezzella, MD, PhD, MSc Stroke Unit, DEM, AOS St Camillo Forlanini, Roma.

“Stroke is a major health concern in Malaysia due to the steady increase in the prevalence of vascular risk factors and a growing number of elderly. Thrombolysis for stroke is in its early days in Malaysia. Because access to the standardized program is free, it should become more wide spread among healthcare providers, just as it has in other countries, and hopefully will lead to a reduction in assessment delays and improved patient care.”–Ramesh Sahathevan, MD, Ph. D, MRCP, M. Med, University Kebangsaan, Malaysia Medical Centre.

“Sharing our intellectual property, including our delivery vehicles and our proprietary database methodologies, has proven to be a successful collaborative model. With the help of champion collaborators, programs like the NIHSS can be delivered to healthcare providers around the world without added financial burdens. Our goal is to continue our collaborative efforts so that all organizations can have an equal opportunity to participate in our global healthcare and clinical research ecosystem, learn best practices and ultimately offer the best possible standard of care.”–Al O. Pacino, President, HealthCarePoint.

NIH Stroke Scale International