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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Modified NIH Stroke Scale/Score (mNIHSS)

    Shortened, validated version of the NIHSS.

    INSTRUCTIONS

    Note: numbering scheme is intentional and reflects differences from the original NIHSS (i.e., 1A, 7 and 10 are eliminated, and 3 and 4 are combined).

    When to Use
    Pearls/Pitfalls
    Why Use

    The mNIHSS can help physicians quantify the severity of a stroke in the acute setting.

    The Modified National Institutes of Health Stroke Scale (mNIHSS) was designed to eliminate the parts of the NIHSS that had poor interrater reliability while maintaining the original score’s utility in assessing stroke severity.

    • Lower is better; increasing mNIHSS scores are correlated with more severe strokes and worsened clinical outcomes.
    • The mNIHSS performs as well as the original score in predicting patients at high risk of hemorrhage if given tPA and which patients are likely to have good clinical outcomes.
    • The mNIHSS has superior interrater reliability (<90%) compared to the original NIHSS (~66%).
    • The mNIHSS is more reliable in multiple settings, including calculating scores from medical records, when used via telemedicine, and when used in clinical trials.

    Points to keep in mind:

    • Currently, the mNIHSS is used much less frequently than the NIHSS in both the clinical setting and in trials.
    • Many guidelines make reference to the NIHSS rather than the mNIHSS, including those making recommendations concerning tPA administration.
    • The NIHSS only takes an average of 6 minutes to complete, so some who question the clinical utility of altering a well-validated and widely used scale.

    There are nearly 800,000 cases of acute stroke in the United States every year, with 130,000 associated deaths (4th leading cause of death in Americans).

    The mNIHSS can help physicians determine the severity of a stroke, predict clinical outcomes and can help guide management.

    The mNIHSS has the same correlation with clinical outcomes as the NIHSS but with better interrater reliability.

    Both questions correct
    0
    1 question correct
    +1
    0 questions correct
    +2
    Both tasks correct
    0
    1 task correct
    +1
    0 tasks correct
    +2
    Normal
    0
    Partial gaze palsy
    +1
    Total gaze palsy
    +2
    No visual loss
    0
    Partial hemianopia
    +1
    Complete hemianopia
    +2
    Bilateral hemianopia
    +3
    No drift
    0
    Drift before 10 seconds
    +1
    Falls before 10 seconds
    +2
    No effort against gravity
    +3
    No movement
    +4
    No drift
    0
    Drift before 10 seconds
    +1
    Falls before 10 seconds
    +2
    No effort against gravity
    +3
    No movement
    +4
    No drift
    0
    Drift before 5 seconds
    +1
    Falls before 5 seconds
    +2
    No effort against gravity
    +3
    No movement
    +4
    No drift
    0
    Drift before 5 seconds
    +1
    Falls before 5 seconds
    +2
    No effort against gravity
    +3
    No movement
    +4
    Normal; no sensory loss
    0
    Abnormal; sensory loss
    +1
    Normal; no aphasia
    0
    Mild aphasia
    +1
    Severe aphasia
    +2
    Mute/global aphasia
    +3
    Normal
    0
    Mild
    +1
    Severe
    +2

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Patrick D. Lyden

    About the Creator

    Patrick D. Lyden, MD is chair of the Department of Neurology, Director of the Stroke Program and holds the Carmen and Louis Warschaw Chair in Neurology at Cedars-Sinai. Previously, he was a professor and vice chairman for clinical neurology at UCSD and served as the Clinical Chief of Neurology and Director of the Stroke Center at UCSD Medical Center. Dr. Lyden has published more than 200 journal articles and abstracts and edited a textbook on stroke intervention.

    To view Dr. Patrick D. Lyden's publications, visit PubMed

    Are you Dr. Patrick D. Lyden? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    About the Creator
    Dr. Patrick D. Lyden
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