Related Experiment Video
Updated: Aug 6, 2026
10:45
The Mouse Stroke Unit Protocol with Standardized Neurological Scoring for Translational Mouse Stroke Studies
Published on: February 7, 2025
NIH Stroke Scale reliability in ratings from a large sample of clinicians
S Andrew Josephson1, Nancy K Hills, S Claiborne Johnston
1Stroke Sciences Group, Department of Neurology, University of California, San Francisco, CA 94143-0114, USA.
Cerebrovascular Diseases (Basel, Switzerland)
|August 5, 2006
Summary
Reliability of the NIH Stroke Scale (NIHSS) certification varied. While individual item scoring was often reliable, total NIHSS scores showed inconsistency among raters, potentially affecting clinical trials.
Area of Science:
- Neurology
- Clinical Trials
- Medical Education
Background:
- The NIH Stroke Scale (NIHSS) is a critical tool in stroke care and research.
- Certification in NIHSS use is standard practice, often via video vignette assessment.
Purpose of the Study:
- To assess the inter-rater reliability of the NIHSS using a large dataset from a common certification examination.
- To identify factors contributing to scoring variability in NIHSS assessments.
Main Methods:
- Analysis of 38,148 NIHSS item responses from 7,405 raters who completed video vignette certification exams (1998-2004).
- Comparison of rater scores using percentiles and modified kappa statistics.
Main Results:
- Overall NIHSS scoring demonstrated significant variability, with 64% of patient scores differing by four or more points between the 5th and 95th percentiles.
- Specific items like aphasia and facial palsy showed the most variance.
- Nurses demonstrated higher agreement with common scoring responses than physicians.
Conclusions:
- While individual NIHSS item reliability is generally good, overall score consistency is lacking among clinicians.
- Inconsistent scoring may impact the validity of clinical trial results.
- Further research is needed on training and examination modifications to enhance NIHSS reliability.
