Journal
ACTA NEUROLOGICA SCANDINAVICA
Volume 143, Issue 4, Pages 375-382Publisher
WILEY
DOI: 10.1111/ane.13388
Keywords
aphasia; language tests; National Institutes of Health Stroke Scale; sensitivity and specificity; stroke
Categories
Funding
- Lunds Universitet
- Fremasons Lodge of Instruction Eos in Lund
- Sparbanksstiftelsen Fars and Frosta
- Swedish Research Council [2019-01757]
- Region Skane
- Swedish Government
- Swedish Heart and Lund Foundation
- Formas [2019-01757] Funding Source: Formas
- Swedish Research Council [2019-01757] Funding Source: Swedish Research Council
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The study examined the diagnostic accuracy of NIHSS for detecting aphasia in acute ischemic stroke patients, showing that NIHSS can detect severe aphasia but may misclassify mild aphasia. With a sensitivity of 72% and a specificity of 95%, absence of aphasia on NIHSS should not be used to guide stroke treatment.
Objectives The National Institutes of Health Stroke Scale (NIHSS) has not been validated to diagnose aphasia in the stroke population. We therefore examined the diagnostic accuracy of NIHSS for detecting aphasia in acute ischemic stroke. Methods Consecutive patients with acute first-ever ischemic stroke were included prospectively in Lund Stroke Register Study at Skane University Hospital, Sweden. Exclusion criteria were: (a) non-native Swedish; (b) obtundation (c) dementia or psychiatric diagnosis. Patients were assessed with NIHSS item 9 (range 0-3, where 1-3 indicate aphasia) by a NIHSS certified research nurse in the acute phase after stroke onset (median 3 days). Within 24 h after this assessment, a speech therapist evaluated the patients' language function with the comprehensive language screening test (LAST, range 0-15 where 0-14 indicates aphasia). Data were analyzed using LAST as 'reference standard'. Results We examined 221 patients. Among these, 23% (n = 50) had aphasia according to NIHSS (distribution of scores 0, 1, 2, 3 were n = 171, n = 29, n = 12, n = 9) compared to 26% (n = 58) with aphasia according to LAST (score <= 14; median = 11). Assuming LAST as reference standard, NIHSS gave 16 false negatives (NIHSS item 9 = 0) for aphasia (LAST scores range 8-14), and 8 false positives (NIHSS item 9 score = 1) for aphasia, yielding a sensitivity of 72% (0.59-0.83) and a specificity of 95% (0.91-0.98). Conclusions When using NIHSS for screening and diagnosing aphasia in adults with acute ischemic stroke, patients with severe aphasia can be detected, however, some mild aphasias might be misclassified. Given the 72% sensitivity, absence of aphasia on the NIHSS should not be used to guide stroke treatment.
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