title: National Institutes of Health Stroke Scale (NIHSS) as An Early Predictor of Poststroke Dysphagia.
abstract: BACKGROUND
  Despite the availability of multiple comprehensive screening methods to detect dysphagia during acute stroke care, consensus is lacking as to the best practice. Our previous study demonstrated favorable sensitivity of the Functional Independence Measure (FIM) compared with a bedside 3-sip test. However, the FIM is challenging to administer during acute stroke care. The National Institutes of Health Stroke Scale (NIHSS) is administered routinely in the emergency department.
  
  
  OBJECTIVE
  To evaluate the utility of the NIHSS as a predictor of clinically relevant poststroke dysphagia compared with FIM data in the same cohort.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Individuals with acute stroke who were admitted for acute care and later transferred to acute rehabilitation within the same institution.
  
  
  METHODS
  Clinically relevant dysphagia was defined as aspiration on modified barium swallow or laryngeal penetration on modified barium swallow requiring diet change, or aspiration pneumonia. NIHSS and FIM scores were compiled for all patients.
  
  
  METHODS
  Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for NIHSS and FIM. Sensitivity and specificity of different values of NIHSS and FIM were analyzed via receiver operator characteristic curves.
  
  
  RESULTS
  Of 290 patients admitted to acute stroke rehabilitation, 88 (30%) manifested clinically relevant dysphagia during their rehabilitation stay. Sensitivity analyses suggested cut-off values for the NIHSS and the FIM of >9 and <55, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for the NIHSS were 75%, 62%, 46%, and 85%, respectively. For the FIM, these parameters were 80%, 72%, 55%, and 92%, respectively.
  
  
  CONCLUSIONS
  The NIHSS >9 and FIM <55 are moderately predictive of clinically relevant dysphagia. Although the NIHSS clinical test characteristics are not as favorable as the FIM, NIHSS appears to be more sensitive than some other reported methods such as a 3-sip water test. Further study into development of paradigms that incorporate NIHSS into initial assessment of dysphagia risk may be appropriate.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH(∗).
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Jeyaseelan
authors.affiliation: Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109(†). Electronic address: mvargo@metrohealth.org.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Vargo
authors.affiliation: Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH(‡).
authors.forename: John
authors.initials: J
authors.lastname: Chae
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D013997:Time Factors; D014481:United States