title: Spanish Version of the National Institutes of Health Stroke Scale: Awareness and Use in United States. A Survey Study.
abstract: OBJECTIVE
  To investigate the awareness and the use of Spanish version of National Institutes of Health Stroke Scale (NIHSS) throughout the United States (US) by regions using a web-based survey.
  
  
  METHODS
  A survey targeting physicians from two specialties that regularly manage acute stroke patients was conducted from February to August of 2015. Academic centers from the Accreditation Council for Graduate Medical Education online directory belonging to emergency medicine (EM) and neurology residency programs were identified. The questionnaire was composed of ten questions separated into three different groups. The responses received from the programs were separated by specialty and grouped into different regions in the US for comparison.
  
  
  RESULTS
  Out of 230 residency-invited programs, we received a total of 73 responses, 35 from EM and 26 responses from neurology residency programs. In addition, 12 respondents were categorized as unknown recipients. The South region had the highest response rate with 30.3%. There was no significant difference in the responses by region if Puerto Rico was not analyzed. Interviewees reported a substantial percentage of Spanish-speaking patients reported across the regions and more than 75% of the programs report lack of knowledge of the Spanish version of the NIHSS and/or the use of it.
  
  
  CONCLUSIONS
  There may be a need to increase awareness and to promote the use of the Spanish version of the NIHSS. Spanish-speaking population in the US may be inaccurately assessed for acute stroke and could impact the outcomes. Larger population studies should be conducted to confirm our findings.
  Dr. Villalobos and Dr. Barnes are involved in formulating the study concept and design; Dr. Rodriguez and Dr. Maud are involved in manuscript writing; Dr. Qureshi is involved in statistical analysis of the data; Dr. Cruz-Flores is involved in critical revision of the manuscript.
  
  
  BACKGROUND
  Dr. Villalobos reports no disclosure; Dr. Barnes reports no disclosure; Dr. Qureshi reports no disclosure; Dr. Cruz-Flores reports no disclosure; Dr. Maud reports no disclosure; Dr. Rodriguez reports no disclosure.
authors.affiliation: Department of Emergency Medicine, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA.
authors.forename: Enrique
authors.initials: E
authors.lastname: Villalobos
authors.affiliation: Department of Emergency Medicine, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Barnes
authors.affiliation: Department of Neurology, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA.
authors.forename: Ihtesham A
authors.initials: IA
authors.lastname: Qureshi
authors.affiliation: Department of Neurology, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA.
authors.forename: Salvador
authors.initials: S
authors.lastname: Cruz-Flores
authors.affiliation: Department of Neurology, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Maud
authors.affiliation: Department of Neurology, Texas Tech University Health Science Center, 4800 Alberta Avenue, El Paso, TX 79905, USA.
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Rodriguez
keywords: National Institutes of Health Stroke Scale (NIHSS); Spanish; Stroke; emergency medicine (EM); neurology; regions