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May 13, 2018

Europe Stroke Organisation Conference

APHASIA DETECTION WITH NIH STROKE SCALE ITEM 9 “BEST LANGUAGE”

;

Grönberg, A.;

Henriksson, I.;

Lindgren, A.

aphasia

nihss

Abstract

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Abstract

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Keywords

aphasia

nihss

Abstract

Aphasia detection with NIH stroke scale item 9 “Best Language” Background: It is unclear how well the National Institutes of Health Stroke Scale (NIHSS) sub-item 9 detects aphasia in stroke patients. We therefore studied if NIH stroke scale subitem 9 is reliable for diagnosing aphasia in the acute phase of ischemic stroke in comparison to a more detailed language screening tool - the Language Screening Test (LAST). We also assessed the incidence of aphasia in patients with first-ever ischemic stroke using NIHSS subitem 9. Methods: A prospective study was carried out with 119 consecutive patients with first-ever ischemic stroke. Patients were included in Lund Stroke Register Study and exclusion criteria were: 1) non-native Swedish language; 2) altered consciousness 3) diagnosed dementia or psychiatric diagnosis. Patients were evaluated by a trained research nurse in the acute phase after stroke (up to 7 days post onset) with the NIHSS sub-item 9 followed by a more detailed language screening with LAST (range 0-15, where 0-14 indicate aphasia and 15 no aphasia) by a speech therapist. These two assessments were made within 24 hours of each other. Data were analysed using LAST as a ‘gold standard.’ Results: 26 patients (22%) had aphasia according to NIHSS sub-item 9 (the distribution of scores 1-3 were n=16, n=5, and n=5, respectively) in comparison to 34 patients (29%) according to LAST (score ≤14, indicating aphasia), with a median score of 11. Assuming LAST as a gold standard, the NIHSS sub-item 9 gave 15 false negatives for aphasia (LAST scores ranging from 8 to 14) and 7 false positives (both with NIHSS sub-item 9 score of 1) for aphasia, corresponding to a sensitivity of 56% and a specificity of 92%. Conclusions: Sub-item 9 = “best language” of the NIH stroke scale has a rather low sensitivity and sometimes misclassifies patients with mild to moderate aphasia, when compared with a diagnostic tool more dedicated towards aphasia.

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All rights reserved.