Predicting the disability post stoke: applying NIHSS in tertiary health care settings

Background& Objectives: Numerous guidelines for the early management of patients with ischemic stroke outline the goals associated with early care encompassing interventions and facilitation of measures aimed at improving consequences post stroke (Adams et al., 2003).One such tool is the National Institutes of Health Stroke Scale (NIHSS) which is a well-validated, reliable scoring system for use specifically with assessing stroke patients (Lyden et al., 1999). Methods: Systemic review of literature from 28 research articles from 1994 to 2014 was conducted through electronic medium by using JPMA, SAGE and Google search engines. Results: Literature findings revealed that during a stroke patient\u27s hospitalization, the NIHSS can be applied to help identify clinical findings that might put the patient at risk for complications. Despite its evidence for validity and reliability, there has been reluctance to implement it within clinical settings. When compared to standard neurological assessments, some users believe that scale completion is too time consuming (Lai, Duncan, & Keighley, 1998). Other detractors perceive a lack of interrater reliability in scoring on certain questions, particularly the questions for ataxia and dysarthria assessment (Lyden, Lu, Levine, Brott, & Broderick, 2001). Others cite a hemispheric bias within the NIHSS, because 7 of the points are directly related to measurement of language (a left hemisphere function) and only 2 points are related to neglect (a right-hemisphere phenomenon). Hence, the NIHSS is believed to underestimate stroke severity in the right hemisphere (Woo et al., 1999). Conclusion: The NIHSS becomes easier and less time consuming to administer if it is made a standard part of nursing practice in order to communicate stroke severity (Criddle et al., 2003). Studies are required to compare its application in Pakistani Tertiary Health Care Settings and its impacts on reducing the disability among patients suffering from stroke. Keywords: NIHSS, Stroke, Neurology, Disabilit