Simplified NIHSS Scale Feasibility Analysis For Optimizing Stroke Green Channel Process

ObjectiveAccording to common stroke symptoms in China,a simplified NIHSS scale is proposed to propose a simple scale suitable for application in China.Emergency doctors,nursing staff,and other non neurology specialists can easily master the scale,reduce the evaluation time of stroke patients during the treatment process,optimize the pre hospital and in hospital treatment processes of stroke centers,and reduce delays caused by poor treatment processes for acute ischemic stroke.Objects and MethodsAnalyzed the clinical manifestations,admission NIHSS score and scores of various items of 200 patients with acute stroke.Admission score was completed by trained neurology specialists.According to clinical manifestations and the results of structural validity analysis of NIHSS scale,NIHSS items were deleted and integrated,and a simplified version was proposed.The simplified version score was obtained directly according to the scores of each single item,and the structural validity and consistency of different simplified scales were analyzed.ResultsThe main manifestations of acute stroke patients were limb weakness,speech ambiguity,mouth skew and paresthesia,but neglect symptoms could not be observed.Factor analysis of NIHSS scale,including consciousness level,gaze level,consciousness level,body movement,sensation,aphasia and dysarthria constitute simplified NIHSS scale(sNIHSS).Factor analysis results of NIHSS scale showed that the ataxia item had a higher load in the 4 factors<0.3,and the other items had a higher load in at least 1 factor,among which the level of consciousness,conscious questioning,conscious command,gaze,right upper limb movement,right lower limb movement,aphasia had a higher load in factor 1(the load value was>0.6).Factor analysis was carried out on sNIHSS,sNIHSS-EMS,sNIHSS-8,sNIHSS-5 and RACE scales respectively.Except RACE scale had one common factor,other scales had two common factors,and each assessment item had high load on at least one factor.The results of consistency analysis suggested that sNIHSS-8 had a good consistency with the complete version of NIHSS scale severity classification(κ value=0.838).The Snihss-EMS,RACE and sNIHSS scales were moderately consistent with the complete NIHSS scales(κ value>0.6).While sNIHSS-5 had poor consistency(κvalue=0.341).The results indicated that the sNIHSS-8 scale had a good consistency with NIHSS scale(κ value>0.8),regardless of whether thrombolytic therapy was received.There was a good agreement between RACE scale ratings and NIHSS(κ=0.814)in patients receiving thrombolytic therapy,but a lower agreement(κ=0.506)in patients not receiving thrombolytic therapy.For Snihss-EMS and sNIHSS,there was a moderate consistency with NIHSS scale ratings in the groups receiving intravenous thrombolytic therapy and non-intravenous thrombolytic therapy(κ value<0.7).Conclusion1.Factor analysis of NIHSS scale suggests that there are 4 factors,and ataxia has a low load on scale structure,suggesting that NIHSS scale has items with low contribution to scale structure,which may be further optimized.2.Factor analysis of different versions of simplified scale suggests that simplified NIHSS scale can reduce the influential factors of scale evaluation from 4 factors to 2 factors or 1 factor,and the load of retained items increases in the scale structure.3.sNIHSS-8,sNIHSS-EMS,RACE,sNIHSS and the complete version of NIHSS scale have good consistency in severity grading.The sNIHSS-5 scale ratings were less consistent with the full NIHSS scale ratings.The simplified scale showed good consistency among patients receiving thrombolytic therapy.