NIHSS Kalkulator za Procenu Moždanog Udara
NIH Stroke Scale (NIHSS) je standardizovana skala od 11 stavki koja omogućava objektivno kvantifikovanje neurološkog deficita kod pacijenta sa moždanim udarom. Izračunavanje skora u prvim minutima od prijema pruža osnovu za donošenje pravovremenih kliničkih odluka. Digitalni kalkulator na Mediately platformi omogućava Vam strukturisano prolazak kroz sve stavke skale i automatski prikaz ukupnog rezultata.
Stavke NIHSS Skale i Rasponi Bodova
| Stavka | Opis | Raspon bodova |
|---|---|---|
| 1a | Nivo svesti | 0-3 |
| 1b | Pitanja o svesti (mesec, starost) | 0-2 |
| 1c | Nalozi za svest (otvaranje/zatvaranje očiju, šaka) | 0-2 |
| 2 | Pokreti pogleda (horizontalni) | 0-2 |
| 3 | Vidno polje | 0-3 |
| 4 | Pareza lica | 0-3 |
| 5a | Motorika ruke - leva | 0-4 |
| 5b | Motorika ruke - desna | 0-4 |
| 6a | Motorika noge - leva | 0-4 |
| 6b | Motorika noge - desna | 0-4 |
| 7 | Ataksija udova | 0-2 |
| 8 | Senzorna funkcija | 0-2 |
| 9 | Govor i jezik (afazija) | 0-3 |
| 10 | Dizartrija | 0-2 |
| 11 | Ekstinkcija i inpažnja | 0-2 |
Ukupni raspon skora: 0-42
Kategorije Težine prema Ukupnom Skoru
| Skor | Kategorija |
|---|---|
| 0 | Bez neurološkog deficita |
| 1-4 | Blagi moždani udar |
| 5-15 | Umereni moždani udar |
| 16-20 | Umereno teški moždani udar |
| 21-42 | Teški moždani udar |
NIHSS — procena težine moždanog udara
NIH Stroke Scale — neurološka procena akutnog ishemijskog moždanog udara
No stroke symptoms
0
1. a) Level of Consciousness
Alert; keenly responsive
The investigator must choose a response if a full evaluation is prevented by such obstacles as an endotracheal tube, language barrier, orotracheal trauma/bandages. A 3 is scored only if the patient makes no movement (other than reflexive posturing) in response to noxious stimulation.
1. b) Ask for the current month and his/her age
Both questions correct
The answer must be correct - there is no partial credit for being close. It is important that only the initial answer be graded and that the examiner not "help" the patient with verbal or non-verbal cues.
1. c) Ask to blink eyes and squeeze hands
Performs both tasks correctly
Substitute another one step command if the hands cannot be used. Credit is given if an unequivocal attempt is made but not completed due to weakness. If the patient does not respond to command, the task should be demonstrated to him or her (pantomime), and the result scored (i.e., follow s none, one or two commands). Patients with trauma, amputation, or other physical impediments should be given suitable one-step commands. Only the first attempt is scored.
2. Test horizontal extraocular movements
Normal
If a patient has an isolated peripheral nerve paresis(CN III, IV or VI), score a 1. Gaze is testable in all aphasic patients. Patients with ocular trauma, bandages, pre-existing blindness, or other disorder of visual acuity or fields should be tested with reflexive movements, and a choice made by the investigator. Establishing eye contact and then moving about the patient from side to side will occasionally clarify the presence of a partial gaze palsy.
3. Test visual fields
No visual loss
Visual fields (upper and lower quadrants) are tested by confrontation, using finger counting or visual threat, as appropriate. Patients may be encouraged, but if they look at the side of the moving fingers appropriately, this can be scored as normal. If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored. Score 1 only if a clear-cut asymmetry, including quadrantanopia, is found.
4. Test facial palsy
Normal (symmetrical movements)
Ask – or use pantomime to encourage – the patient to show teeth or raise eyebrows and close eyes. Score symmetry of grimace in response to noxious stimuli in the poorly responsive or non-comprehending patient. If facial trauma/bandages, orotracheal tube, tape or other physical barriers obscure the face, these should be removed to the extent possible.
5. a) Test left arm motor drift
No drift for 10 Seconds
The limb is placed in the appropriate position: extend the arms (palms down) 90 degrees (if sitting) or 45 degrees (if supine). Drift is scored if the arm falls before 10 seconds. The aphasic patient is encouraged using urgency in the voice and pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with the non-paretic arm. Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as untestable (UN).
5. b) Test right arm motor drift
No drift for 10 Seconds
The limb is placed in the appropriate position: extend the arms (palms down) 90 degrees (if sitting) or 45 degrees (if supine). Drift is scored if the arm falls before 10 seconds. The aphasic patient is encouraged using urgency in the voice and pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with the non-paretic arm. Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as untestable (UN).
6. a) Test left leg motor drift
No drift for 5 seconds
The limb is placed in the appropriate position: hold the leg at 30 degrees (always tested supine). Drift is scored if the leg falls before 5 seconds. The aphasic patient is encouraged using urgency in the voice and pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with the non-paretic leg. Only in the case of amputation or joint fusion at the hip, the examiner should record the score as untestable (UN), and clearly write the explanation for this choice.
6. b) Test right leg motor drift
No drift for 5 seconds
The limb is placed in the appropriate position: hold the leg at 30 degrees (always tested supine). Drift is scored if the leg falls before 5 seconds. The aphasic patient is encouraged using urgency in the voice and pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with the non-paretic leg. Only in the case of amputation or joint fusion at the hip, the examiner should record the score as untestable (UN), and clearly write the explanation for this choice.
7. Test limb ataxia
No ataxia
This item is aimed at finding evidence of a unilateral cerebellar lesion. Test with eyes open. In case of visual defect, ensure testing is done in intact visual field. The finger-nose-finger and heel-shin tests are performed on both sides, and ataxia is scored only if present out of proportion to weakness. In case of blindness, test by having the patient touch nose from extended arm position.
8. Test sensation
Normal (no sensory loss)
Sensation or grimace to pinprick when tested, or withdrawal from noxious stimulus in the obtunded or aphasic patient. Only sensory loss attributed to stroke is scored as abnormal and the examiner should test as many body areas (arms [not hands], legs, trunk, face) as needed to accurately check for hemisensory loss.
9. Test language
No aphasia; normal
If visual loss interferes with the tests, ask the patient to identify objects placed in the hand, repeat, and produce speech. The intubated patient should be asked to write. The examiner must choose a score for the patient with stupor or limited cooperation, but global aphasia answer should be used only if the patient is mute and follows no one-step commands.
10. Test dysarthria
Normal
If patient is thought to be normal, an adequate sample of speech must be obtained by asking patient to read or repeat words. If the patient has severe aphasia, the clarity of articulation of spontaneous speech can be rated. Only if the patient is intubated or has other physical barriers to producing speech, the examiner should record the score as untestable. Do not tell the patient why he or she is being tested.
11. Test extinction and inattention
No abnormality
Sufficient information to identify neglect may be obtained during the prior testing. If the patient has a severe visual loss preventing visual double simultaneous stimulation, and the cutaneous stimuli are normal, the score is normal. If the patient has aphasia but does appear to attend to both sides, the score is normal. The presence of visual spatial neglect or anosagnosia may also be taken as evidence of abnormality. Since the abnormality is scored only if present, the item is never untestable.
Kada Primeniti NIHSS Kalkulator
- Pri inicijalnoj proceni pacijenta sa akutnim neurološkim deficitom na urgentnom prijemu
- Pre razmatranja indikacija za intravensku trombolizu alteplazom ili mehaničku trombektomiju
- Pri serijskom praćenju neurološkog statusa tokom hospitalizacije u jedinici za moždani udar
- Kod ponovljene procene pri promeni kliničkog stanja pacijenta
- Kao standardizovani dokumentacioni alat pri transferu pacijenta između odeljenja ili ustanova
Ograničenja Skale
- NIHSS precenjuje težinu deficit kod posteriorne cirkulacije jer posjeduje manji broj stavki koje procenjuju cerebelarnu i trunkusnu funkciju.
- Skala može podproceniti deficit kod blagog ili fluktuirajućeg moždanog udara.
- Rezultat odražava status u momentu procene i ne zamenjuje celokupni klinički pregled.
- Primena od strane neuvežbanih ispitivača može uvesti varijabilnost; preporučuje se prethodna obuka i sertifikacija.
- Skor ne uzima u obzir prethodne neurološke deficite koji mogu maskirati ili pojačati izmerenu vrednost.
Često Postavljana Pitanja
Da li NIHSS kalkulator mogu koristiti lekari koji nisu neurolozi? NIHSS je dizajniran tako da ga mogu primenjivati i lekari koji nisu specijalisti neurologije, uključujući urgentne medicine i interne medicine, pod uslovom da su prošli standardizovanu obuku. Brojna istraživanja potvrdila su pouzdanost primene od strane neurologa i neureurga, ali i lekara urgentne medicine uz prethodnu edukaciju. Konsultujte smernice Vašeg establishmenta o procedurama sertifikacije.
Koliko dugo traje procena po NIHSS? Iskusan ispitivač završava kompletnu procenu za oko 7 minuta. Digitalni kalkulator na Mediately platformi strukturiše procenu korak po korak, što olakšava sistematski pristup i smanjuje verovatnoću preskakanja stavki.
Da li se NIHSS menja tokom hospitalizacije? Da. Serijska primena NIHSS preporučuje se pri inicijalnoj proceni, nakon primene trombolize ili trombektomije i u redovnim vremenskim intervalima tokom hospitalizacije. Promene skora od 4 ili više bodova smatraju se klinički značajnim pogoršanjem ili poboljšanjem.
Izvori
- Brott T, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989.
- Lyden P, et al. Improved reliability of the NIH Stroke Scale using video training. Stroke. 1994.
- European Stroke Organisation (ESO). Guidelines for the Management of Ischaemic Stroke and Transient Ischaemic Attack. 2008, updated 2021.
- American Heart Association / American Stroke Association (AHA/ASA). Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2019.
- Sociedade Neurologica Srbije. Konsenzus dokument o prevenciji, lečenju i rehabilitaciji moždanog udara. 2022.
