Use of the e-NIHSS to Capture Posterior Circulation Strokes.

Background The National Institutes of Health Stroke Scale (NIHSS) is used to quantify stroke severity. However, it favors detection of signs and symptoms indicative of anterior rather than posterior circulation strokes, especially in the middle cerebral artery. Purpose A prospective study explored the feasibility of use of the e-NIHSS by medical- surgical stroke nurse responders. Secondarily, it described the correlation between e-NIHSS findings and diagnosis of posterior circulation stroke determined by the neurologist based on clinical and neurodiagnostic results. Method A prospective, exploratory design was used to determine effectiveness of the e-NIHSS in identifying posterior circulation strokes in an urban emergency department. Results Nine patients were diagnosed with a posterior circulation stroke based on imaging, with three having trunk ataxia identified by nurse stroke responders. Subjective findings included complaints of nausea and vomiting, dizziness, lightheadedness, and headache. In 40 assessments, there were no positive findings using the e-NIHSS; in these 40 cases, neuroimaging was negative for acute stroke. Tongue deviation and trunk ataxia was noted in patients without pathology or posterior circulation stroke on imaging. Sensitivity was calculated at 33% and specificity 83%. Conclusion The additional six e-NIHSS items are easy to assess, except standing the patient was found to be challenging physically and required excessive time. Trunk ataxia, falling to one side when sitting up, suggested posterior circulation compromise. [ABSTRACT FROM AUTHOR]

Copyright of MEDSURG Nursing is the property of Jannetti Publications, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)