title: Establishment of the Thai version of National Institute of Health Stroke Scale (NIHSS) and a validation study.
abstract: 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.
authors.affiliation: Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. siysl@mahidol.ac.th
authors.forename: Yongchai
authors.initials: Y
authors.lastname: Nilanont
authors.forename: Sucheera
authors.initials: S
authors.lastname: Phattharayuttawat
authors.forename: Pipat
authors.initials: P
authors.lastname: Chiewit
authors.forename: Songkram
authors.initials: S
authors.lastname: Chotikanuchit
authors.forename: Juljak
authors.initials: J
authors.lastname: Limsriwilai
authors.forename: Lultrita
authors.initials: L
authors.lastname: Chalernpong
authors.forename: Napaporn
authors.initials: N
authors.lastname: Yamkaew
authors.forename: Niramol
authors.initials: N
authors.lastname: Lirathpong
authors.forename: Pornpimol
authors.initials: P
authors.lastname: Anprasertporn
authors.forename: Chulaluk
authors.initials: C
authors.lastname: Komoltri
authors.forename: Naraporn
authors.initials: N
authors.lastname: Prayoonwiwat
authors.forename: Niphon
authors.initials: N
authors.lastname: Poungvarin
mesh_terms: 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