Screening at a National Scale: NIHSS Plus Test of Gait Plus Test of Skew

In 2020, we recommended that our clinicians perform NIHSS plus test of gait and test of skew in patients with undifferentiated dizziness, vertigo, ataxia, and imbalance, as well as any patient suspected of having a posterior stroke. Our mnemonic for this practice change is “dizziNIHSS,” which seems to resonate with our clinicians.

On a per patient volume basis from 2018–present, malpractice claims for missed posterior stroke presenting as undifferentiated dizziness have decreased by 50 percent (internal data), suggesting the NIHSS plus test of skew plus test of gait is effective in preventing posterior stroke misses and claims.

Summary

We advocate for the use of the NIHSS with a test of skew and test of gait to screen for stroke in patients presenting with dizziness, vertigo, ataxia, imbalance, and other clinical suspicion for posterior circulation stroke. This approach has strong evidence, is well accepted by clinicians, and has cut our predicted malpractice costs by 50 percent.

References

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