The Accuracy of Administrative NIHSS Scores in Assessing Stroke Severity

Accurately evaluating the extent of neurological damage caused by an acute ischemic stroke, a medical condition resulting from impaired blood supply to the brain, is essential for providing effective and timely treatment. The National Institutes of Health Stroke Scale (NIHSS) is a widely used tool for this purpose, providing a standardized method to evaluate a patient's neurological deficits.

In a recent study in BMJ Neurology, John D. MacArthur Research Professor of Health Policy and Management, Joseph Newhouse,  joins a team of researchers to comparethe accuracy of NIHSS scores recorded in medical records with those captured administratively through insurance claims. The hypothesis was that the administrative data, while collected for billing purposes, could potentially serve as a reliable surrogate for the clinical assessment of stroke severity.

The researchers leveraged a linked dataset comprising the Paul Coverdell National Acute Stroke Program (PCNASP) clinical registry and matched individuals on Medicare Claims data. This allowed for a direct comparison between the clinical NIHSS scores and those recorded in the administrative claims.   

The analysis revealed a high degree of concordance between the clinical and administrative NIHSS scores, suggesting that the insurance claims data can serve as a reliable proxy for the clinical assessment. This finding has significant implications for stroke research and clinical practice, as it opens up new avenues for large-scale studies and population-based analyses.

The high agreement between clinical and administrative NIHSS scores has several implications:

  • Research: Administrative data can be used to conduct large-scale studies on stroke epidemiology, risk factors, and outcomes.
  • Clinical Practice: Insurance claims data can be used to monitor stroke quality of care and identify areas for improvement.
  • Policy: The availability of reliable administrative data can inform healthcare policy decisions related to stroke prevention, treatment, and rehabilitation.

In conclusion, this study demonstrates the potential of administrative data to provide valuable insights into stroke severity and facilitate research and clinical practice.