Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.
Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden.
Acta Neurol Scand. 2021 Apr;143(4):375-382. doi: 10.1111/ane.13388. Epub 2020 Dec 27.
The National Institutes of Health Stroke Scale (NIHSS) has not been validated to diagnose aphasia in the stroke population. We therefore examined the diagnostic accuracy of NIHSS for detecting aphasia in acute ischemic stroke.
Consecutive patients with acute first-ever ischemic stroke were included prospectively in Lund Stroke Register Study at Skåne University Hospital, Sweden. Exclusion criteria were: (a) non-native Swedish; (b) obtundation (c) dementia or psychiatric diagnosis. Patients were assessed with NIHSS item 9 (range 0-3, where 1-3 indicate aphasia) by a NIHSS certified research nurse in the acute phase after stroke onset (median 3 days). Within 24 h after this assessment, a speech therapist evaluated the patients' language function with the comprehensive language screening test (LAST, range 0-15 where 0-14 indicates aphasia). Data were analyzed using LAST as 'reference standard'.
We examined 221 patients. Among these, 23% (n = 50) had aphasia according to NIHSS (distribution of scores 0, 1, 2, 3 were n = 171, n = 29, n = 12, n = 9) compared to 26% (n = 58) with aphasia according to LAST (score ≤14; median = 11). Assuming LAST as reference standard, NIHSS gave 16 false negatives (NIHSS item 9 = 0) for aphasia (LAST scores range 8-14), and 8 false positives (NIHSS item 9 score = 1) for aphasia, yielding a sensitivity of 72% (0.59-0.83) and a specificity of 95% (0.91-0.98).
When using NIHSS for screening and diagnosing aphasia in adults with acute ischemic stroke, patients with severe aphasia can be detected, however, some mild aphasias might be misclassified. Given the 72% sensitivity, absence of aphasia on the NIHSS should not be used to guide stroke treatment.
国立卫生研究院卒中量表（NIHSS）尚未经过验证，无法用于诊断卒中人群中的失语症。因此，我们研究了 NIHSS 对急性缺血性卒中患者中失语症的诊断准确性。
我们连续纳入了在瑞典斯科讷大学医院隆德卒中登记研究中首次发生急性缺血性卒中的患者。排除标准为：（a）非母语为瑞典语；（b）意识障碍；（c）痴呆或精神科诊断。在卒中发病后急性期（中位数 3 天），由 NIHSS 认证的研究护士通过 NIHSS 项目 9（范围 0-3，其中 1-3 表示失语症）对患者进行评估。在此次评估后 24 小时内，语言治疗师通过全面语言筛查测试（LAST，范围 0-15，其中 0-14 表示失语症）评估患者的语言功能。数据采用 LAST 作为“参考标准”进行分析。
我们共检查了 221 例患者。其中，根据 NIHSS，23%（n=50）患者有失语症（评分 0、1、2、3 的分布例数分别为 n=171、n=29、n=12、n=9），而根据 LAST，26%（n=58）患者有失语症（评分≤14，中位数=11）。如果以 LAST 为参考标准，NIHSS 对失语症有 16 例假阴性（NIHSS 项目 9=0），8 例假阳性（NIHSS 项目 9 评分=1），因此敏感性为 72%（0.59-0.83），特异性为 95%（0.91-0.98）。
在使用 NIHSS 对急性缺血性卒中成人进行失语症筛查和诊断时，可检测到严重失语症患者，但一些轻度失语症可能会被误诊。鉴于 NIHSS 的 72%敏感性，NIHSS 无失语症不能用于指导卒中治疗。
