What is the NIH Stroke Scale and how is it used in the ED?

• A. An 11-item scale assessing level of consciousness, language, neglect, visual fields, gaze, ataxia, and motor function; scores 0-42; higher scores indicate more severe deficits
• B. A 5-item scale for mood assessment
• C. An imaging-based scale
• D. Used only after 24 hours

Answer: (A)

The NIH Stroke Scale is a rapid bedside tool used to quantify neurologic deficit in acute stroke. It includes 11 items that evaluate level of consciousness and cognitive function, language, neglect, visual fields, gaze, facial palsy, limb motor function (arm and leg), limb ataxia, dysarthria, and extinction/inattention. Each item is scored, and the total ranges from 0 to 42, with higher scores indicating more severe deficits. In the ED, it’s performed right away on arrival to establish a baseline severity, guide urgent treatment decisions (such as eligibility for reperfusion therapy), and monitor changes over time to detect improvement or deterioration. It is not a mood assessment, not imaging-based, and not limited to 24 hours after onset.