NIH STROKE SCALE ASSIGNMENT
SUSPECTED ADULT STROKE ALGORITHM-
2: 2025/2026 UPDATED
NATIONAL INSTITUTES OF HEALTH
STROKE SCALE (NIHSS)
ROLE OF THE NIH STROKE SCALE IN THE ALGORITHM
The NIHSS is a systematic 15-item neurological exam used to quantify the
severity of neurological deficits caused by an acute stroke. A trained
observer performs the scale without coaching the patient, and scores range
from 0 (normal/no deficit) to 42 (severe stroke)
The results of the NIHSS are crucial in Algorithm-2 for:
Determining Stroke Severity: The score helps classify the stroke as mild (1-5),
ACLS Reference Manual Chapter
Suspected Adult Stroke
Download Suspected Adult Stroke
moderate (5-14), or severe (15-24).
Guiding Treatment Decisions: Specific NIHSS cut-off scores (e.g., a score of 6 or
higher for endovascular therapy consideration) determine a patient's eligibility for
advanced therapies like intravenous (IV) fibrinolytic therapy (tPA) or mechanical
thrombectomy.
Monitoring Changes: The scale is used as a baseline and is repeated frequently to
monitor for patient improvement or deterioration.
,
, The acute adult stroke diagram outlines all of the steps for
assessment and treatment of suspected ischemic stroke
according to AHA guidelines.
In the following pages the suspected stroke algorithm will be
reviewed step-by-step.
You may wish to download and review the Suspected Adult
Stroke Algorithm Diagram before proceeding.
Suspected Adult Stroke Algorithm Diagram
Download Suspected Adult Stroke Algorithm Diagram
Click the NEXT button to begin your review of the Suspected
Adult Stroke Algorithm
Step 1 - Stroke Algorithm
Early Identification and EMS Activation
Early identification of stroke symptoms in the out-of-hospital setting
is critical for improved outcomes. Every year nearly 800,000 people
suffer from a stroke. Eighty-seven percent of these strokes are
ischemic and if caught early could potentially be treated with
fibrinolytic therapy.
Since the goal of stroke therapy is to minimize brain injury and
maximize recovery, early recognition of acute ischemic stroke and
activation of EMS is the first step in the stroke algorithm.
Signs and symptoms of stroke include rapid onset of any of the
following symptoms: weakness or numbness which will most likely
be
SUSPECTED ADULT STROKE ALGORITHM-
2: 2025/2026 UPDATED
NATIONAL INSTITUTES OF HEALTH
STROKE SCALE (NIHSS)
ROLE OF THE NIH STROKE SCALE IN THE ALGORITHM
The NIHSS is a systematic 15-item neurological exam used to quantify the
severity of neurological deficits caused by an acute stroke. A trained
observer performs the scale without coaching the patient, and scores range
from 0 (normal/no deficit) to 42 (severe stroke)
The results of the NIHSS are crucial in Algorithm-2 for:
Determining Stroke Severity: The score helps classify the stroke as mild (1-5),
ACLS Reference Manual Chapter
Suspected Adult Stroke
Download Suspected Adult Stroke
moderate (5-14), or severe (15-24).
Guiding Treatment Decisions: Specific NIHSS cut-off scores (e.g., a score of 6 or
higher for endovascular therapy consideration) determine a patient's eligibility for
advanced therapies like intravenous (IV) fibrinolytic therapy (tPA) or mechanical
thrombectomy.
Monitoring Changes: The scale is used as a baseline and is repeated frequently to
monitor for patient improvement or deterioration.
,
, The acute adult stroke diagram outlines all of the steps for
assessment and treatment of suspected ischemic stroke
according to AHA guidelines.
In the following pages the suspected stroke algorithm will be
reviewed step-by-step.
You may wish to download and review the Suspected Adult
Stroke Algorithm Diagram before proceeding.
Suspected Adult Stroke Algorithm Diagram
Download Suspected Adult Stroke Algorithm Diagram
Click the NEXT button to begin your review of the Suspected
Adult Stroke Algorithm
Step 1 - Stroke Algorithm
Early Identification and EMS Activation
Early identification of stroke symptoms in the out-of-hospital setting
is critical for improved outcomes. Every year nearly 800,000 people
suffer from a stroke. Eighty-seven percent of these strokes are
ischemic and if caught early could potentially be treated with
fibrinolytic therapy.
Since the goal of stroke therapy is to minimize brain injury and
maximize recovery, early recognition of acute ischemic stroke and
activation of EMS is the first step in the stroke algorithm.
Signs and symptoms of stroke include rapid onset of any of the
following symptoms: weakness or numbness which will most likely
be
