Comparison of a standard neurological tool with a stroke scale for detecting symptomatic cerebral vasospasm

The purpose of this study was to critically analyze the effectiveness of two tools used by nurses to assess neurological status of individuals at risk of developing cerebral vasospasm following aneurysmal subarachnoid hemorrhage due to aneurysm rupture. Early detection of vasospasm provides an opportunity for prompt treatment so that further ischemia or infarction can be prevented. We hypothesized that the National Institutes of Health Stroke Scale would detect symptomatic vasospasm earlier than the standard neurological record currently used in the practice setting of a tertiary care teaching hospital. Thirty participants were entered into the study, and a differential diagnostic process identified 15 with symptomatic vasospasm. Quantitative prospective and retrospective analysis showed that there was no statistical difference between the two scales in early detection of vasospasm. This finding may partially be explained by the clinical similarities between the vasospasm and nonvasospasm groups and by the challenges experienced by nurses in administering the stroke scale. Clinically relevant observations suggested the stroke scale was more effective in the assessment of focal symptoms. Qualitative content analysis of nursing notes also provided insight into clinical findings not captured on either scale regarding generalized changes such as restlessness, impulsiveness, and unusual behavior. This study demonstrates the need to develop a more appropriate tool for early detection of vasospasm.