Abstract WP312: Application of the e-NIHSS at a Tertiary Care Stroke Center: Experience and Results
| Autor: | Kylie B Floyd, Susan B. Fowler, Christian A. Rosado |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Advanced and Specialized Nursing
medicine.medical_specialty business.industry Stroke scale medicine.disease Tertiary care Emergency medicine Medicine Center (algebra and category theory) cardiovascular diseases Neurology (clinical) Cardiology and Cardiovascular Medicine business Stroke Time sensitive |
| Zdroj: | Stroke. 50 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/str.50.suppl_1.wp312 |
| Popis: | Background and Purpose: Stroke is a time sensitive emergency with proper identification and rapid evaluation critical. The National Institutes of Health Stroke Scale (NIHSS) is used to quantify stroke severity. The NIHSS favors detection of signs and symptoms indicative of anterior circulation strokes, especially MCA territory. Capturing signs and symptoms associated with posterior circulation strokes is limited in the present NIHSS. Methods: This prospective study explored if the e-NIHSS utilized by stroke nurse responders correlated with the diagnosis of posterior circulation stroke determined by the neurologist based on clinical and radiographic findings. A secondary objective was to determine ease of use, including time for completion, of the expanded items on the NIHSS. Results: In 40 assessments, there were no positive findings using the e-NIHSS; in these 40 cases, the CT or MRI was negative for acute stroke. In 4 cases, positive e-NIHSS findings (3 - CN XII: tongue turns to one side and 1- Trunk Ataxia: falls back to one side) were noted but imaging was negative for acute stroke. In 5 patients, tongue (N=4) and trunk ataxia (N=1) were positively assessed with resulting positive imaging for anterior circulation stroke. Nine patients were diagnosed with a posterior circulation stroke based on imaging with 3 having trunk ataxia identified by nurse stroke responders. Subjective findings included complaints of nausea/vomiting, dizziness, lightheadedness, and/or headache. Sensitivity was calculated at 33%, specificity 82%, positive predictive value 25%, negative predictive value 87%, and 74% accuracy. Conclusions: Findings are limited to small sample size (N=96) and low incidence of posterior circulation strokes. The additional 6 e-NIHSS items are easy to assess except standing the patient was found to be challenging physically and timewise. Assessment of soft palate paralysis was not specific to posterior circulation. Trunk ataxia, falling to one side when sitting up, identified posterior circulation compromise. |
| Databáze: | OpenAIRE |
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