Establishment of the Thai version of National Institute of Health Stroke Scale (NIHSS) and a validation study.
BACKGROUND
The National Institute of Health Stroke Scale (NIHSS) is a well validated stroke severity assessment scale. The scale is used to assess neurological deficits, progression and degree of recovery in acute stroke settings. To date, no Thai version exists.


OBJECTIVE
This study aimed to adapt and validate a Thai version of the NIHSS (NIHSS-T).


METHODS
A cross-cultural adaptation of the NIHSS was developed according to the methods recommended by the International Quality of Life Assessment Project Group. Forward and backward translations were performed. A final version of the NIHSS-T was validated against initial MRI infarction volume and modified Rankin Scale (mRS) at 3 months in a consecutive series of acute stroke patients. The patients were prospectively evaluated by 3 different types of health care providers: 2 stroke fellows, 2 internists, and 2 stroke nurses. Mean NIHSS-T scores from all raters were used in the analysis.


RESULTS
The study included 32 acute ischemic stroke patients with a mean age (+/- SD) of 64.53 +/- 14.97 years of age. Men comprised 71.9%. Mean NIHSS-T score (+/- SD) was 7.49 +/- 7.02. Intra-observer reliability demonstrated a high agreement with an intraclass correlation (ICC) of 0.98, 0.98, 0.96, 0.98, 0.90 and 0.98 for 2 stroke fellows, 2 internists and 2 stroke nurses respectively. Inter-observer reliability between 6 raters was excellent, i.e.; ICC, 0.99 (0.98, 0.99). Spearman rank correlation coefficients between the initial NIHSS-T score versus initial MRI lesion volume and mRS at 3 months were 0.53 and 0.69 with a p-value of 0.002 and < 0.001 respectively.


CONCLUSIONS
The Thai version of NIHSS is valid for assessing acute stroke severity. The scale is also reliable when administered in a Thai-speaking setting by trained healthcare professionals.
Nilanont
Yongchai
Y
Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. siysl@mahidol.ac.th
Phattharayuttawat
Sucheera
S
Chiewit
Pipat
P
Chotikanuchit
Songkram
S
Limsriwilai
Juljak
J
Chalernpong
Lultrita
L
Yamkaew
Napaporn
N
Lirathpong
Niramol
N
Anprasertporn
Pornpimol
P
Komoltri
Chulaluk
C
Prayoonwiwat
Naraporn
N
Poungvarin
Niphon
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002545:Brain Ischemia / Q000145:classification* / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification* / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology; D009626:Terminology as Topic; D013785:Thailand; D014481:United States