Measuring neurological severity and complexity in acute setting: the modified Neurological Impairment Scale

Area of Science:

• Neurology
• Clinical Assessment
• Health Services Research

Background:

• Standardized protocols are crucial for assessing diverse neurological conditions in acute settings.
• The Neurological Impairment Scale (NIS) requires modification to meet current clinical needs.
• Evaluating neurological impairment severity and complexity necessitates refined assessment tools.

Purpose of the Study:

• To standardize the assessment of neurological impairment severity and complexity in acute inpatients.
• To validate a modified Neurological Impairment Scale (mNIS) for clinical use.
• To develop a mNIS Complexity Index (mNIS-CI) for patient stratification.

Main Methods:

• A modified Neurological Impairment Scale (mNIS) was applied to 1081 consecutively hospitalized neurological inpatients.
• Multidimensional assessments included multimorbidity, frailty, functional dependency, and neurological impairment.
• Inter-rater reliability and construct validity of mNIS were evaluated against established scales, including the National Institutes of Health Stroke Scale.

Main Results:

• The mNIS demonstrated remarkable inter-rater reliability (ICC 0.90) for total and subscores.
• Strong construct validity was observed for mNIS total and subscores compared to other clinical scales (r 0.47-0.97, p<0.001).
• The mNIS Complexity Index (mNIS-CI) effectively stratified patients based on neurological impairment severity and domains involved.

Conclusions:

• The modified Neurological Impairment Scale (mNIS) is a valuable tool for assessing neurological severity and complexity in acute inpatients.
• The mNIS shows significant potential for broader application across various clinical settings.
• Standardized assessment using mNIS aids in managing diverse neurological patient populations.