What is the National Institutes of Health (NIH) scale score for a patient with decreased sensitivity in two or more extremities?

NIH Stroke Scale Score for Sensory Assessment (Item 8)

For a patient with decreased sensitivity in two or more extremities, the appropriate NIH Stroke Scale score for item 8 (Sensory) is 2, which indicates "severe sensory loss." 1

Understanding the NIH Stroke Scale Sensory Assessment

The NIH Stroke Scale (NIHSS) is a standardized tool used to assess stroke severity, with scores ranging from 0 to 42, where higher scores indicate more severe strokes. Item 8 specifically evaluates sensory function using the following scoring criteria:

• 0 = No sensory loss - Normal sensation when tested with pinprick or patient is alert and responsive with no evidence of sensory deficit 1
• 1 = Mild to moderate unilateral sensory loss - The patient feels pinprick is less sharp or is dulled on the affected side, or there is a loss of superficial pain with pinprick but patient is aware of being touched 1
• 2 = Severe sensory loss - Patient is not aware of being touched in two or more extremities, or there is total loss of sensation in a specific distribution 1

Clinical Assessment Technique

The proper technique for assessing sensory function involves:

• Using a safety pin or other sharp object to test sensation 1
• Testing both sides of the body, including face, arms, and legs 1
• Observing for grimace or withdrawal if the patient is stuporous 1
• Scoring only stroke-related sensory losses 1

Clinical Significance and Implications

• Sensory deficits are common manifestations of stroke and contribute to the overall NIHSS score 1
• Higher NIHSS scores correlate with poorer outcomes, with scores >20 indicating large strokes with only 4-16% chance of favorable outcomes at one year 1
• Severe sensory loss (score of 2) contributes significantly to functional disability and may affect rehabilitation potential 1

Common Pitfalls in Assessment

• Do not confuse decreased level of consciousness with sensory loss 1
• When a patient has decreased sensitivity in two or more extremities, this represents severe sensory loss and warrants the maximum score of 2 points on item 8 1
• Remember to distinguish between unilateral sensory loss (score of 1) and bilateral or multiple extremity involvement (score of 2) 1

Importance in Stroke Management

• The NIHSS score helps quantify the degree of neurological deficit and facilitates communication between healthcare professionals 1
• It helps identify the possible location of vessel occlusion and provides early prognosis 1
• The score assists in identifying patient eligibility for various interventions and the potential for complications 1