De Rubeis Gianluca, Chaturvedi Seemant, Kamel Hooman, Meschia James, Pampana Enrico, Saba Luca
Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy.
Department of Neurology, University of Maryland, and Baltimore VA Hospital, Baltimore, MD, USA.
Neurol Sci. 2025 Jan;46(1):227-237. doi: 10.1007/s10072-024-07733-z. Epub 2024 Sep 6.
The National Institutes of Health Stroke Scale (NIHSS) is a pivotal clinical tool used to assess patients with acute stroke. However, substantial heterogeneity in the application and interpretation of stroke scale items can occur. This systematic review aimed to elucidate heterogeneity in measuring the NIHSS.
A literature search was performed on PubMed/OVID/Cochran's CENTRAL from inception to 2023. The references of the included papers were reviewed for further eligible articles. Clinical characteristic, NIHSS values, and sources of heterogeneity were recorded. Non-human and non-English language articles were excluded. The study quality was assessed using MINORS and GRADE. Meta-analysis and meta-regression were performed using a random-effects model to explore the sources of heterogeneity.
Twenty-one papers for a total of 818 patients (mean per study: 39 ± 37) and 9696 NIHSS examinations (median per study: 8 [CI95% 2 to 42]) were included. Motor function had a higher ICC agreement (ranging from 0.85 ["Right Leg"] to 0.90 ["Right Arm"]) compared to the remaining items (ranging from 0.58 ["Facial Palsy"] to 0.85 ["Level of consciousness commands"]. The meta-regression showed a low effect size of covariates such as language version, remote evaluation, and retrospective analysis on NIHSS items (e.g., for "Level of consciousness commands," language effect was 0.30 [CI95% 0.20 to 0.48] and for "Visual", the retrospective assessment effect was -0.27 [CI95% -0.51 to -0.03]).
The NIHSS scores showed moderate to excellent inter-rater agreement, with the highest heterogeneity in non-motor function evaluation. Using a non-English version, remote evaluation and retrospective analysis had small effects in terms of heterogeneity in the NIHSS scores.
美国国立卫生研究院卒中量表（NIHSS）是用于评估急性卒中患者的关键临床工具。然而，卒中量表项目的应用和解释可能存在显著异质性。本系统评价旨在阐明NIHSS测量中的异质性。
在PubMed/OVID/Cochrane中心数据库中进行从创建至2023年的文献检索。对纳入论文的参考文献进行审查以获取更多符合条件的文章。记录临床特征、NIHSS值和异质性来源。排除非人类和非英语语言的文章。使用MINORS和GRADE评估研究质量。采用随机效应模型进行荟萃分析和荟萃回归以探索异质性来源。
纳入21篇论文，共818例患者（每项研究平均：39±37）和9696次NIHSS检查（每项研究中位数：8 [CI95% 2至42]）。与其余项目（范围从0.58 ["面瘫"]至0.85 ["意识水平指令"]）相比，运动功能具有更高的组内相关系数一致性（范围从0.85 ["右腿"]至0.90 ["右臂"]）。荟萃回归显示语言版本、远程评估和回顾性分析等协变量对NIHSS项目的效应量较低（例如，对于“意识水平指令”，语言效应为0.30 [CI95% 0.20至0.48]，对于“视觉”，回顾性评估效应为 -0.27 [CI95% -0.51至 -0.03]）。
NIHSS评分显示出中度至高度的评分者间一致性，非运动功能评估中的异质性最高。使用非英语版本、远程评估和回顾性分析对NIHSS评分的异质性影响较小。
