MDCalc

Pediatric NIH Stroke Scale (NIHSS)

Quantifies stroke severity using a child-specific version of the NIH Stroke Score.

Administer the questions in the order below. In order to improve score accuracy, emphasize with family members the need to refrain from hinting at the correct responses to questions asked.

1A. Level of consciousness
1B. Ask age and to point out family member
Ask the child “how old are you?”, give credit if child states correct age or shows correct number of fingers for age; ask the child “where is X?” (X = parent or other familiar family member present), give credit if child correctly points/gazes purposefully in the direction of the family member
1C. Command to blink eyes and touch nose
2. Horizontal extraocular movements
Only assess horizontal gaze
3. Visual fields
Use finger counting (if >6 years old) or visual threat (if 2-6 years old) as appropriate
4. Facial palsy
5A. Left arm motor drift
Drift is scored if the arm falls before 10 sec; for children too young to follow precise directions or uncooperative, grade power by observation of spontaneous or elicited movement
5B. Right arm motor drift
Drift is scored if the arm falls before 10 sec; for children too young to follow precise directions or uncooperative, grade power by observation of spontaneous or elicited movement
6A. Left leg motor drift
Drift is scored if the leg falls before 5 sec; for children too young to follow precise directions or uncooperative, grade power by observation of spontaneous or elicited movement
6B. Right leg motor drift
Drift is scored if the the leg falls before 5 sec; for children too young to follow precise directions or uncooperative, power in each limb should be graded by observation of spontaneous or elicited movement
7. Limb ataxia
Ask child to reach for a toy, or ask child to kick a toy or the examiner’s hand in children <5 years or otherwise uncooperative for the standard exam
8: Sensation
Pin-prick test; for children too young or otherwise uncooperative for reporting gradations of sensory loss, observe for any behavioral response to pin prick
9. Best language
If age ≥6 years with normal language development before onset of stroke, ask child to describe picture, to name items, repeat words, read sentences (see below); for children age 2-6 years, score item based on observations of language comprehension and speech during the examination

Repetition test:

Reading test:

Fluency test:

Naming test:

10. Dysarthria
Ask patient to read or repeat words (as above)
11. Extinction and inattention

Result:

Please fill out required fields.
Advice

Pediatric stroke is overall rare, and the true predictive value of the PedNIHSS is subject to change as the scale continues to be studied. Retrospective application of the PedNIHSS has been shown to be valid and reliable in one cross-sectional study (see Beslow 2012).

Management

  • This score has not been validated in hemorrhagic stroke; in such cases, the need for emergent neurosurgical consult is clear.

  • Given the overall rarity of pediatric stroke, the benefit of tPA is not well defined in the literature, emphasizing the importance of expert consultation.

Critical Actions

Children with sickle cell disease presenting with acute ischemic stroke will likely benefit from emergent blood transfusion to reduce hyperviscosity caused by sickled cells. Early consultation with a pediatric hematologist is recommended in addition to child neurology consult.

Have feedback about this calculator?