Richard Shih, MD, FACEP Stroke Patient and ED Stroke Patient and ED Stroke Therapy Stroke Therapy Assessments: Assessments: What Does Every Emergency What Does Every Emergency Physician Need to Know About Physician Need to Know About the NIHSS & Other Stroke the NIHSS & Other Stroke Scales? Scales?
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Richard Shih, MD, FACEP Stroke Patient and ED Stroke Therapy Assessments: What Does Every Emergency Physician Need to Know About the NIHSS & Other Stroke.
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Richard Shih, MD, FACEP
Stroke Patient and ED Stroke Stroke Patient and ED Stroke Therapy Assessments: Therapy Assessments:
What Does Every Emergency What Does Every Emergency Physician Need to Know About Physician Need to Know About
the NIHSS & Other Stroke the NIHSS & Other Stroke Scales?Scales?
Richard Shih, MD, FACEP
Emergency Medicine Emergency Medicine AssociatesAssociates
Atlantic City, NJAtlantic City, NJSeptember 26-27, 2006September 26-27, 2006
Richard Shih, MD, FACEP
2006 Advanced Emergency 2006 Advanced Emergency & Acute Care Medicine and & Acute Care Medicine and
Technology ConferenceTechnology Conference
Richard Shih, MD, FACEP
Richard Shih, MD, FACEP
Program Director
Department of Emergency Medicine
Morristown Memorial Hospital, Morristown, NJ
Richard Shih, MD, FACEP
DisclosuresDisclosures
• All past advisory board or speakers’ All past advisory board or speakers’ bureau activities have expired within bureau activities have expired within the past yearthe past year
Richard Shih, MD, FACEP
Sessions ObjectivesSessions Objectives
• Review stroke scalesReview stroke scales• Discuss the NIH stroke scale Discuss the NIH stroke scale
(NIHSS)(NIHSS)• Discuss NIHSSS and prognosisDiscuss NIHSSS and prognosis• Discuss implications of NIHSS Discuss implications of NIHSS
Stroke ScaleStroke Scale• Katz Index of ADL Katz Index of ADL • Kenny Self-Care Kenny Self-Care
Evaluation Evaluation • Hemispheric Hemispheric
Stroke Scale Stroke Scale • Barthel IndexBarthel Index
• Orgogozo Scale Orgogozo Scale • Canadian Stroke Canadian Stroke
ScaleScale• The Activity IndexThe Activity Index• Canadian Canadian
Neurological Scale Neurological Scale • Toronto Stroke Toronto Stroke
Scale Scale • Mathew Stroke Mathew Stroke
Scale Scale
Richard Shih, MD, FACEP
Stroke ScalesStroke Scales
• Used for stroke assessmentUsed for stroke assessment• Initial use for clinical trialsInitial use for clinical trials• Many different types:Many different types:
-Global Outcome Scales -Global Outcome Scales
-Physical Deficit Scales -Physical Deficit Scales
-Activities of Daily Life Scales-Activities of Daily Life Scales
Richard Shih, MD, FACEP
Global Outcome ScalesGlobal Outcome Scales
• Global ranking on one or more broad Global ranking on one or more broad scalesscales
• Poor reproducibility and sensitivityPoor reproducibility and sensitivity• Rankin scale (modified Rankin scale)Rankin scale (modified Rankin scale)
Richard Shih, MD, FACEP
Modified Rankin ScaleModified Rankin Scale
Richard Shih, MD, FACEP
Stroke ScalesStroke Scales
• Global Outcome Scales Global Outcome Scales • Rankin ScaleRankin Scale
• Physical Deficit ScalesPhysical Deficit Scales• Activities of Daily Life ScalesActivities of Daily Life Scales
Richard Shih, MD, FACEP
Physical Deficit ScalesPhysical Deficit Scales
• Stroke related deficits based on Stroke related deficits based on neurologic examinationneurologic examination
• NIH Stroke Scale (NIHSS)NIH Stroke Scale (NIHSS)• 15 point assessment based on 3 15 point assessment based on 3
previously used scales previously used scales • Designed for non-neurologist Designed for non-neurologist • Good reliabilityGood reliability
• Activities of Daily Life ScalesActivities of Daily Life Scales
Richard Shih, MD, FACEP
Activities of Daily Life ScalesActivities of Daily Life Scales
• Measures functions useful for daily Measures functions useful for daily living living
• More useful for studies of rehabilitation More useful for studies of rehabilitation • Impractical in setting of acute strokeImpractical in setting of acute stroke• The Barthel IndexThe Barthel Index