ArticleCureus2023
Reliability of the National Institutes of Health (NIH) Stroke Scale Between Emergency Room and Neurology Physicians for Initial Stroke Severity Scoring.
Article in Cureus, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed.
- Rehabilitation of patients in the subacute phase of stroke using the ReHand robotic system: a randomized controlled trial.Frontiers in human neuroscience · 2025Trial
- Post-stroke facial palsy: Prevalence, recovery patterns within the first 7 days, risk factors, and effect of hyperacute treatments.Clinical rehabilitation · 2026Article
- Risk factors and development of a prediction model for hematoma expansion in elderly patients with spontaneous intracerebral hemorrhage.Frontiers in aging neuroscience · 2026Article
- Prehospital stroke care in low- and middle-income countries: A World Stroke Organization (WSO) scientific statement.International journal of stroke : official journal of the International Stroke Society · 2025Review
- Comparing Emergency Medicine and Neurology Residents in Assessing Stroke Severity Using the NIHSS.AEM education and training · 2025Article
- Benzodiazepine Initiation and the Risk of Falls or Fall-Related Injuries in Older Adults Following Acute Ischemic Stroke.Neurology. Clinical practice · 2025Article
- Impact of Pre-Hospital and in-Hospital Optimization on the Management of Intravenous Thrombolysis in Hyperacute Ischemic Stroke: A Scoping Review.Risk management and healthcare policy · 2025Review
- Diffusion-weighted imaging and the Alberta Stroke Program Early CT Score (DWI-ASPECTS)-guided intra-arterial thrombectomy beyond 6 hours: feasibility, substantial efficacy, and acceptable safety.American journal of translational research · 2025Article
- Management of antimicrobial therapy in emergency department admissions and hospitalizations for firearm injuries: A single-center experience.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2024Article
- Prevalence and influencing factors of malnutrition in stroke patients with bulbar paralysis: a cross-sectional study in China.Frontiers in nutrition · 2024Article
- Deep learning for prediction of post-thrombectomy outcomes based on admission CT angiography in large vessel occlusion stroke.Frontiers in artificial intelligence · 2024Article
- A novel automated CT biomarker to predict outcomes in acute ischemic stroke: net water uptake.Frontiers in neurologyArticle
- Comparing the National Institutes of Health Stroke Scale Scores between emergency medicine physicians and neurologists for timely decision-making for alteplase administration.Turkish journal of emergency medicineArticle
- The formulation of an individualized nursing plan for elderly patients with acute cerebral infarction based on comfort nursing intervention and its influence on patient comfort.Frontiers in neurologyArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIn patients with acute ischemic stroke (AIS), the National Institutes of Health Stroke Scale (NIHSS) is essential to establishing a patient's initial stroke severity. While previous research has validated NIHSS scoring reliability between neurologists and other clinicians, it has not specifically evaluated NIHSS scoring reliability between emergency room (ER) and neurology physicians within the same clinical scenario and timeframe in a large cohort of patients. This study specifically addresses the key question: does an ER physician's NIHSS score agree with the neurologist's NIHSS score in the same patient at the same time in a real-world context?
methodsData was retrospectively collected from 1,946 patients being evaluated for AIS at Houston Methodist Hospital from 05/2016 - 04/2018. Triage NIHSS scores assessed by both the ER and neurology providers within one hour of each other under the same clinical context were evaluated for comparison. Ultimately, 129 patients were included in the analysis. All providers in this study were NIHSS rater-certified.
resultsThe distribution of the NIHSS score differences (ER score - neurology score) had a mean of -0.46 and a standard deviation of 2.11. The score difference between provider teams ranged ±5 points. The intraclass correlation coefficient (ICC) for the NIHSS scores between the ER and neurology teams was 0.95 (95% CI, 0.93 - 0.97) with an F-test of 42.41 and a p-value of 4.43E-69. Overall reliability was excellent between the ER and neurology teams.
conclusionWe evaluated triage NIHSS scores performed by ER and neurology providers under matching time and treatment conditions and found excellent interrater reliability. The excellent score agreement has important implications for treatment decision-making during patient handoff and further in stroke modeling, prediction, and clinical trial registries where missing NIHSS scores may be equivalently substituted from either provider team.
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