In emergency department stroke consultations, the NIHSS alone does not appear to be a reliable guide for ordering diagnostic tests for a LVO, according to large body of data presented at AAN2023 AANAM
consultations, the National Institute of Health Stroke Scale alone does not appear to be a reliable guide for ordering diagnostic tests for a large vessel occlusion , according to large body of data presented at the 2023 annual meeting of the American Academy of Neurology.
"The current guidelines do not address low NIHSS score largely due to a paucity of data," according to Dr. Sevilis, who showed data indicating that there is great variation among institutions in regard to ordering computed tomography angiography . She indicated that CTA is the current imaging standard for detecting LVO.consultations in the emergency departments in 227 facilities in 27 states. Stroke consultations over a 6-month period from July through December 2021 were evaluated.
In the group with NIHSS score of 6 or above, 24.1% were found to have an LVO. Of these, the proportion accepted for a mechanical thrombectomy was less than half. The intervention acceptance rate for mechanical intervention among LVOs in patients with lower NIHSS scores again fell incrementally by score. The acceptance rate was about 35% among LVO patients with a NIHSS score of 3 or 4 and 25% for those with a score of 0-2.
A more important step will be ongoing trials designed specifically to generate data to answer this question. Pascal Jabbour, MD, chief of the division of neurovascular and endovascular neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, is participating in one of these trials. He agreed with the premise that better evidence-based criteria are needed when evaluating acute stroke patients with a potential LVO.
For determining whether to order a CTA,"I do not agree with NIHSS score of 6 or above. There is no absolute number below which risk of missing a LVO is eliminated," Dr. Jabbour said. He also argued against relying on NIHSS score without considering other clinical features, particularly cortical signs, which should raise suspicion of a LVO regardless of NIHSS score.
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