Free tool · Scored assessment · ER / stroke
NIHSS — NIH Stroke Scale.
The standard 15-item exam for quantifying stroke severity. Score each item and get the total (0–42) with the common severity band. The scale is the public-domain NIH / NINDS instrument used since the original rt-PA trials. It quantifies the deficit and tracks change over time — but it's time-critical and one input: the stroke team and imaging decide on thrombolysis and thrombectomy, and reliable scoring requires NIHSS certification.
Score the 15 items
Score what you observe — do not coach the patient, and score the first attempt (not the best). "UN" (untestable, e.g., amputation or intubation) is recorded but adds 0 to the total. The total updates as you go.
Score all 15 items to see the total and severity band.
Severity bands [2]
| NIHSS total | Severity (common grouping) |
|---|---|
| 0 | No stroke symptoms |
| 1–4 | Minor stroke |
| 5–15 | Moderate stroke |
| 16–20 | Moderate to severe stroke |
| 21–42 | Severe stroke |
Total 0–42 across the 15 items. These bands are a widely-used interpretive grouping — the NIH scale itself is a continuous severity measure, not an officially banded one.[2] The NIHSS guides — but does not by itself decide — acute treatment: thrombolysis (tPA/TNK) and thrombectomy decisions are made by the stroke team using the exam, time of onset, imaging, and contraindications. A normal-looking score can still miss a disabling posterior-circulation stroke.
References
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health. NIH Stroke Scale. Bethesda, MD: NIH (public domain). ninds.nih.gov; Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–870. PMID: 2749846. (15 items; total 0–42; item descriptors transcribed from the public-domain scale.)
- NIH Stroke Scale severity grouping (0; 1–4 minor; 5–15 moderate; 16–20 moderate–severe; 21–42 severe) — widely used interpretive bands; see e.g. MDCalc NIHSS and standard stroke references.
- Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke (AHA/ASA). ahajournals.org. (NIHSS in acute ischemic stroke evaluation and treatment decisions.)
The NIH Stroke Scale is a U.S. government (public-domain) instrument. Item descriptors and the total range were transcribed from it; the severity bands are a common interpretive convention. Your stroke protocol takes precedence at the bedside.
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