To evaluate the degree of correlation between nursing neuro-checks and National Institute of Health Stroke Scale (NIHSS) in acute stroke.

Neuro-checks used in stroke units to detect deterioration are summarized neurological exams. Despite widespread use, their effectiveness has not been validated. We assessed the degree of correlation with the well-validated and more complete NIHSS.

This retrospective chart review of alteplase-treated strokes at a large Comprehensive Stroke Center during 2017 recorded demographics, baseline and 24-hour NIHSS score, vascular syndrome and neuro-check findings during the first 72 hours. Neuro-checks assess Glasgow Coma Scale, and arm and leg strength and sensation. Rates of correlation between overlapping components of neuro-checks and NIHSS (orientation, motor, sensory) were analyzed.

A total of 107 patients were analyzed (52% male, age 69.7±15.6 [mean+/-SD] years).  Mean NIHSS score was 12±7.3 on arrival and 7.8±7.6 at 24 hours. An average of 63.3±13.9 neuro-checks were performed per patient. There was a lack of correlation between initial NIHSS and neuro-checks in 32% of the cases, most pronounced for those with right vs. left MCA syndrome (50 vs. 30%, p=0.04). Lack of correlation was observed more frequently when taking into account only the motor component in those with right vs. left MCA syndrome (36 vs. 15%, p=0.05). Other components were similar between the two groups. Lack of correlation at 24 hours was noted in 25%, also more common in right vs. left MCA syndrome (29.7% vs. 18.9%, p=0.70). Again, the motor component had a lower correlation in those with right MCA syndrome (29 vs. 18%, p =0.47).

Poor correlation was noted between NIHSS and Neuro-checks, particularly in non-dominant hemispheric strokes. A more detailed examination may be required in these patients.