| ARCHETYPE ID | openEHR-EHR-OBSERVATION.nihss.v0 |
| Concept | NIHSS |
| Description | 15-item neurologic examination stroke scale that provides a quantitative measure of stroke-related neurological deficit. |
| Use | Used to record the results of NIHSS scoring as a quantitative measurement of stroke-related neurological deficits. The total score is the arithmetic sum of all 15 responses, with all 'untestable' values excluded. The ordinal value '99' is included to represent the non-numeric value 'untestable'. Currently, neither modeling tools nor existing openEHR journal systems allow for a combination of numeric and non-numeric values within a single value set. |
| Purpose | To record the results of NIHSS as a quantitative measurement of stroke-related neurologic deficit. |
| References | National Institute of Health. NIH Stroke Scale [Internet]. Bethesda, MD: National Institute of Health; [cited 2025 Mar 11]. Available from: https://www.ninds.nih.gov/health-information/stroke/assess-and-treat/nih-stroke-scale Kristensen DV, Johnsen NT, Amthor KF, Lunde L, Strømmen LB, Vestby EM, et al. Validated translation of the NIHSS with cultural adaptation [Internet]. Sykepleien Research. 2020;15(82736):e-82736. Available from: https://sykepleien.no/forskning/2020/11/validert-oversettelse-av-nihss-med-kulturell-tilpasning |
| Copyright | © openEHR Foundation |
| Authors | Author name: Gustavo M Bacelar-Silva Organisation: Healthcare Designs Email: mail@gustavobacelar.com Date originally authored: 2012-05-11 |
| Other Details Language | Author name: Gustavo M Bacelar-Silva Organisation: Healthcare Designs Email: mail@gustavobacelar.com Date originally authored: 2012-05-11 |
| OtherDetails Language Independent | {licence=This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/., custodian_organisation=openEHR Foundation, references=National Institute of Health. NIH Stroke Scale [Internet]. Bethesda, MD: National Institute of Health; [cited 2025 Mar 11]. Available from: https://www.ninds.nih.gov/health-information/stroke/assess-and-treat/nih-stroke-scale
Kristensen DV, Johnsen NT, Amthor KF, Lunde L, Strømmen LB, Vestby EM, et al. Validated translation of the NIHSS with cultural adaptation [Internet]. Sykepleien Research. 2020;15(82736):e-82736. Available from: https://sykepleien.no/forskning/2020/11/validert-oversettelse-av-nihss-med-kulturell-tilpasning, current_contact=Heather Leslie, Atomica Informatics |
| Keywords | scale, neurological, stroke, assessment, examination, NIHSS |
| Lifecycle | in_development |
| UID | 6359150e-4104-4044-b81d-855ba7c4b643 |
| Language used | en |
| Citeable Identifier | 1246.145.2490 |
| Revision Number | 0.0.1-alpha |
| All | Archetype [runtimeNameConstraintForConceptName=null, archetypeConceptBinding=null, archetypeConceptDescription=15-item neurologic examination stroke scale that provides a quantitative measure of stroke-related neurological deficit., archetypeConceptComment=NIHSS - National Institutes of Health Stroke Scale., otherContributors=Gustavo Bacelar-Silva, Healthcare Designs, Portugal Silje Ljosland Bakke, Nasjonal IKT HF, Norway (openEHR Editor) Rong Chen, Cambio Healthcare Systems, Sweden Ricardo Cruz-Correia, Faculty of Medicine of Porto University, Portugal Heather Leslie, Atomica Informatics, Australia (openEHR Editor), originalLanguage=en, translators=
1: Not Alert; but arousable by minor stimulation to obey, answer, or respond. 2: Not Alert; requires repeated stimulation to attend, or is obtunded and requires strong or painful 3: Responds only with reflex motor or autonomic effects, or totally unresponsive, flaccid, and areflexic. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0009], code=at0009, itemType=ELEMENT, level=4, text=LOC questions, description=Level of Consciousness, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: Answers both questions correctly. 1: Answers one question correctly. 2: Answers neither question correctly. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0013], code=at0013, itemType=ELEMENT, level=4, text=LOC commands, description=Level of Consciousness, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: Performs both tasks correctly. 1: Performs one task correctly. 2: Performs neither task correctly. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0017], code=at0017, itemType=ELEMENT, level=4, text=Best Gaze, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: Normal. 1: Partial gaze palsy; gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is not present. 2: Forced deviation, or total gaze paresis is not overcome by the oculocephalic maneuver. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0021], code=at0021, itemType=ELEMENT, level=4, text=Visual, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: No visual loss. 1: Partial hemianopia. 2: Complete hemianopia. 3: Bilateral hemianopia (blind including cortical blindness). , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0026], code=at0026, itemType=ELEMENT, level=4, text=Facial palsy, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: Normal symmetrical movements. 1: Minor paralysis (flattened nasolabial fold, asymmetry on smiling). 2: Partial paralysis (total or near-total paralysis of lower face). 3: Complete paralysis of one or both sides (absence of facial movement in the upper and lower face). , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0031], code=at0031, itemType=ELEMENT, level=4, text=Motor - left arm, description=Observation of left arm motor function., comment=Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as 'Untestable' and record the reason in the 'Reason left arm untestable' data element. Implementation note: Although the 'Untestable' value is included in the ordinal to allow its inclusion in the user interface dropdown menu, NIHSS does not assign a numerical score for the 'Untestable' option in the total NIHSS score., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: No drift; limb holds 90 (or 45) degrees for full 10 seconds. 1: Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support. 2: Some effort against gravity; limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity. 3: No effort against gravity; limb falls. 4: No movement. 99: Untestable: Amputation or joint fusion. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0037], code=at0037, itemType=ELEMENT, level=4, text=Reason left arm untestable, description=Amputation or joint fusion, explain:, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0038], code=at0038, itemType=ELEMENT, level=4, text=Motor - right arm, description=Observation of right arm motor function., comment=Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as 'Untestable' and record the reason in the 'Reason right arm untestable' data element. Implementation note: Although the 'Untestable' value is included in the ordinal to allow its inclusion in the user interface dropdown menu, NIHSS does not assign a numerical score for the 'Untestable' option in the total NIHSS score., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: No drift; limb holds 90 (or 45) degrees for full 10 seconds. 1: Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support. 2: Some effort against gravity; limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity. 3: No effort against gravity; limb falls. 4: No movement. 99: Untestable: Amputation or joint fusion. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0045], code=at0045, itemType=ELEMENT, level=4, text=Reason right arm untestable, description=Amputation or joint fusion, explain:, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0046], code=at0046, itemType=ELEMENT, level=4, text=Motor - left leg, description=Observation of left leg motor function., comment=Only in the case of amputation or joint fusion at the hip, the examiner should record the score as 'Untestable' and record the reason in the 'Reason left leg untestable' data element. Implementation note: Although the 'Untestable' value is included in the ordinal to allow its inclusion in the user interface dropdown menu, NIHSS does not assign a numerical score for the 'Untestable' option in the total NIHSS score., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: No drift; leg holds 30-degree position for full 5 seconds. 1: Drift; leg falls by the end of the 5-second period but does not hit the bed. 2: Some effort against gravity; leg falls to bed by 5 seconds but has some effort against gravity. 3: No effort against gravity; leg falls to bed immediately. 4: No movement. 99: Untestable: Amputation or joint fusion. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0053], code=at0053, itemType=ELEMENT, level=4, text=Reason left leg untestable, description=Amputation or joint fusion, explain:, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0141], code=at0141, itemType=ELEMENT, level=4, text=Motor - right leg, description=Observation of right leg motor function., comment=Only in the case of amputation or joint fusion at the hip, the examiner should record the score as 'Untestable' and record the reason in the 'Reason right leg untestable' data element. Implementation note: Although the 'Untestable' value is included in the ordinal to allow its inclusion in the user interface dropdown menu, NIHSS does not assign a numerical score for the 'Untestable' option in the total NIHSS score., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: No drift; leg holds 30-degree position for full 5 seconds. 1: Drift; leg falls by the end of the 5-second period but does not hit the bed. 2: Some effort against gravity; leg falls to bed by 5 seconds but has some effort against gravity. 3: No effort against gravity; leg falls to bed immediately. 4: No movement. 99: Untestable: Amputation or joint fusion. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0060], code=at0060, itemType=ELEMENT, level=4, text=Reason right leg untestable, description=Amputation or joint fusion, explain:, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0061], code=at0061, itemType=ELEMENT, level=4, text=Limb ataxia, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: Absent 1: Present in one limb 2: Present in two limbs 99: Untestable: Amputation or joint fusion, explain: , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0066], code=at0066, itemType=ELEMENT, level=4, text=Reason limb ataxia untestable, description=Untestable: Amputation or joint fusion, explain:, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0067], code=at0067, itemType=ELEMENT, level=4, text=Sensory, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: Normal; no sensory loss. 1: Mild-to-moderate sensory loss; patient feels pinprick is less sharp or is dull on the affected side; or there is a loss of superficial pain with pinprick, but patient is aware of being touched. 2: Severe or total sensory loss; patient is not aware of being touched in the face, arm, and leg. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0071], code=at0071, itemType=ELEMENT, level=4, text=Best Language, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: No aphasia; normal. 1: Mild-to-moderate aphasia; some obvious loss of fluency or facility of comprehension, without significant limitation on ideas expressed or form of expression. Reduction of speech and/or comprehension, however, makes conversation about provided materials difficult or impossible. For example, in conversation about provided materials, examiner can identify picture or naming card content from patient’s response. 2: Severe aphasia; all communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener. Range of information that can be exchanged is limited; listener carries burden of communication. Examiner cannot identify materials provided from patient response. 3: Mute, global aphasia; no usable speech or auditory comprehension. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0076], code=at0076, itemType=ELEMENT, level=4, text=Dysarthria, description=, comment=Only if the patient is intubated or has other physical barriers to producing speech, the examiner should record the score as 'Untestable' and record the reason in the 'Reason speech untestable' data element. Implementation note: Although the 'Untestable' value is included in the ordinal to allow its inclusion in the user interface dropdown menu, NIHSS does not assign a numerical score for the 'Untestable' option in the total NIHSS score., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: Normal 1: Mild-to-moderate dysarthria; patient slurs at least some words and, at worst, can be understood with some difficulty. 2: Severe dysarthria; patient’s speech is so slurred as to be unintelligible in the absence of or out of proportion to any dysphasia, or is mute/anarthric. 99: Untestable: Intubated or other physical barrier. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0081], code=at0081, itemType=ELEMENT, level=4, text=Reason speech untestable, description=Intubated or other physical barrier, explain:, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0082], code=at0082, itemType=ELEMENT, level=4, text=Extinction and inattention, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=0: No abnormality. 1: Visual, tactile, auditory, spatial, or personal inattention, or extinction to bilateral simultaneous stimulation in one of the sensory modalities. 2: Profound hemi-inattention or extinction to more than one modality; does not recognize own hand or orients to only one side of space. , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0086], code=at0086, itemType=ELEMENT, level=4, text=Total score, description=The total score is the arithmetic sum of all 15 responses, excluding any untestable responses., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_COUNT, bindings=null, values=min: >=0; max: <=42 , extendedValues=null]], description=[], provider=[], contacts=[], events=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002], code=at0002, itemType=POINT_EVENT, level=2, text=Baseline, description=Baseline assessment., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=POINT_EVENT, bindings=null, values=null, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0087], code=at0087, itemType=POINT_EVENT, level=2, text=2 hours post treatment, description=Assessment carried out 2 hours post treatment., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=POINT_EVENT, bindings=null, values=null, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0088], code=at0088, itemType=POINT_EVENT, level=2, text=24 hours post symptom onset, description=Assessment carried out 24 hours post onset of symptoms (with tolerance of +-20 minutes)., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=POINT_EVENT, bindings=null, values=null, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0089], code=at0089, itemType=POINT_EVENT, level=2, text=7–10 days, description=Assessment carried out 7-10 days after stroke., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=POINT_EVENT, bindings=null, values=null, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0090], code=at0090, itemType=POINT_EVENT, level=2, text=3 months, description=Assessment carried out 3 months after stroke., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=POINT_EVENT, bindings=null, values=null, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0091], code=at0091, itemType=EVENT, level=2, text=Any event, description=Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=EVENT, bindings=null, values=null, extendedValues=null]], protocol=[ResourceSimplifiedHierarchyItem [path=/protocol[at0092]/items[at0093], code=at0093, itemType=SLOT, level=2, text=Extension, description=Additional information required to extend the model with local content or to align with other reference models or formalisms., comment=For example: local information requirements; 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