Time for a standardized neurological assessment in acute setting: the modified Neurological Impairment scale

BackgroundGiven the increasing diversity among neurological patients, standardized protocols are essential for evaluating the severity and complexity of the variety of conditions. Aim of the present work was to standardize the assessment of the severity and complexity of neurological impairment in an acute setting by using a modified version of the Neurological Impairment Scale (mNIS). Methodsconsecutively hospitalized neurological inpatients underwent a multidimensional standardized assessment of multimorbidity, frailty, functional dependency, and neurological impairment using mNIS and other validated scales. Inter-rater reliability of the mNIS total and sub-scores was evaluated. Construct validity was assessed separately in patients with Cerebrovascular disease performing correlations between corresponding sub-scores of mNIS, original NIS, and National Institutes of Health Stroke Scale (NIHSS). mNIS Complexity Index (mNIS-CI) for neurological severity was used to classify patients into subtle, mild, moderate, and severe impairment. Resultsone thousand eighty-one neurological patients admitted to a neurological ward from the emergency setting were enrolled. The inter-rater reliability was remarkable for mNIS total and sub-scores (ICC 0.90, 95% CI 0.82-0.95). The mNIS showed strong construct validity for total and sub-scores compared to other clinical scales (r 0.47-0.97, p<0.001) and 52.7% of patients scored at least one in one of the four newly listed items. The stratification of patients according to mNIS-CI exhibited high construct validity distinguishing the extent of impairment and involved domains. ConclusionsThe mNIS is valuable for measuring neurologic severity and complexity in acute inpatients and holds significant potential for application in different settings. What is already known on this topicStandardization of neurological assessment and development of functional rating scales of global impairment are pivotal to characterize and follow up patients both in the clinical practice and in the research setting. What this study addsmNIS is a valuable tool to measure neurologic severity and complexity in acute inpatients: the four added items are useful for capturing a broader spectrum of signs and symptoms; the severity and complexity scores provide different information about neurological status and domain imapired at individual level. How this study might affect research, practice, or policymNIS can be instrumental in grading the severity of neurological conditions, tracking clinical progress, and gauging response to treatments in the acute setting.