Inconsistent Classification of Mild Stroke and Implications on Health Services Delivery.
Pamela S Roberts, Shilpa Krishnan, Suzanne Perea Burns and 2 others
PMID 32001257WHAT IT FOUND
Mild stroke is defined inconsistently across the literature, with ten different cutoff scores on the National Institute of Health Stroke Scale alone.
This confusion likely contributes to patients being misclassified and missing out on necessary rehabilitation referrals and services.
Key findings
01There is no global consensus on the definition of mild stroke, leading to variability in treatment and outcomes.
02The National Institute of Health Stroke Scale was the most common assessment tool, but studies used ten different cutoff scores to define mild stroke.
03Patients with mild stroke often do not receive rehabilitation services due to symptoms appearing non-disabling, despite long-term deficits.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review only included articles published in English, which may limit the global applicability of the findings. As a scoping review, it may have missed some relevant studies due to database selection and search term constraints. The review did not include studies that used subjective perspectives of patients or caregivers to define mild stroke, potentially missing patient-reported outcomes. The definition of Transient Ischemic Attack (TIA) changed in 2009, which may have led to the exclusion or misclassification of some studies published before that date.
Declared interests
The authors declared no conflicts of interest. The work was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and the National Institute of Neurological Disorders and Stroke (NINDS).
The easy way to misread this
Do not assume that a low NIHSS score confirms a patient does not need rehabilitation. The study shows that NIHSS cutoffs for 'mild' stroke vary widely and the scale itself may not detect subtle functional impairments in activity and participation, leading to missed referrals.