What are the assessment scales for Cerebrovascular Accident (CVA)?

From the Guidelines

The National Institutes of Health Stroke Scale (NIHSS) is the most widely used and recommended tool for assessing stroke severity, as it provides a standardized and reliable measure of neurological deficits. The NIHSS measures 15 specific neurological deficits on a scale from 0-42, with higher scores indicating greater impairment 1. Other assessment scales, such as the modified Rankin Scale (mRS), Barthel Index, Glasgow Coma Scale (GCS), and Functional Independence Measure (FIM), are also used to evaluate patients with cerebrovascular accidents (CVAs or strokes) and provide valuable information on functional independence, activities of daily living, consciousness, and motor and cognitive functions 1.

Key Assessment Scales

• National Institutes of Health Stroke Scale (NIHSS): measures stroke severity, with scores ranging from 0-42
• Modified Rankin Scale (mRS): evaluates functional independence, with scores from 0-6
• Barthel Index: assesses activities of daily living, with scores from 0-100
• Glasgow Coma Scale (GCS): evaluates consciousness, with scores ranging from 3-15
• Functional Independence Measure (FIM): provides detailed assessment of motor and cognitive functions, with 18 items

Recommendations for Use

• The NIHSS should be used at various time points, including initially in the emergency setting, during hospitalization, and throughout rehabilitation to track progress and adjust treatment plans accordingly 1.
• Other assessment scales should be used in conjunction with the NIHSS to provide a comprehensive evaluation of the patient's condition and guide treatment decisions 1.
• The use of standardized assessment scales can help clinicians quantify stroke severity, monitor recovery progress, and predict outcomes, ultimately improving patient care and outcomes 1.

From the Research

CVA Assessment Scales

• The National Institutes of Health Stroke Scale (NIHSS) is a widely used assessment scale for stroke patients, which has been evaluated as a potential primary outcome measure for trials of acute treatment for ischemic stroke 2.
• The modified Rankin Scale (mRS) is another commonly used scale to assess the functionality of stroke patients, and its validity and reliability have been extensively studied 3.
• The NIHSS, mRS, and modified Thrombolysis in Cerebral Infarction (mTICI) have been found to be predictive tools of the functionality of patients with ischemic stroke, especially in the acute phase 4.
• A systematic review and analysis found that early NIHSS assessment may provide practical benefits over 90-day mRS, but it is unclear how it compares in adjudicating randomized clinical trial (RCT) results in acute ischemic stroke 5.
• Nurses can use the NIHSS to assess acute stroke survivors, and its implementation has been supported by best practice guidelines, which can enhance neurological assessment and provide optimal management to obtain favorable patient outcomes 6.

Comparison of Assessment Scales

• The NIHSS and mRS have been compared in several studies, with findings suggesting that the NIHSS can be used as a primary outcome measure in trials of acute treatment for ischemic stroke, particularly in phase II(b) trials 2.
• The agreement between trial results based on 24-hour NIHSS and 90-day mRS scores has been found to be intermediate-to-good, with a Cohen's kappa of 0.64 and Gwet's agreement coefficient 1 of 0.79 5.
• Individual patient data have shown that early NIHSS risks misclassifying around 1/4 patients, highlighting the need for careful consideration when using the NIHSS as an outcome measure in acute ischemic stroke RCTs 5.

Clinical Applications

• The use of the NIHSS and mRS can provide valuable information for decision-makers in stroke clinical trials, and can help to reduce trial duration and costs 2.
• The implementation of best practice guidelines for neurological assessment using the NIHSS can enhance nursing practice and provide optimal management to obtain favorable patient outcomes 6.
• The NIHSS, mRS, and mTICI can be used to predict the functionality of patients with ischemic stroke, and can inform rehabilitation plans and long-term care decisions 4.