Variation and trends in the documentation of national institutes of health stroke scale in GWTG-stroke hospitals

Mathew J. Reeves, Eric E. Smith, Gregg C. Fonarow, Xin Zhao, Michael Thompson, Eric D. Peterson, Lee H. Schwamm, Daiwai Olson

Research output: Contribution to journalArticle

13 Scopus citations


Background - Although National Institutes of Health Stroke Scale (NIHSS) is an important prognostic variable, it is often incompletely documented in clinical registries, such as Get With The Guidelines (GWTG)-Stroke. We describe trends in NIHSS documentation by GWTG-Stroke hospitals, identify patient-level and hospital-level factors associated with documentation, and determine the degree to which the reporting of NIHSS is potentially biased. Methods and Results - We analyzed NIHSS documentation in 1 184 288 patients with acute ischemic stroke admitted to 1704 GWTG-Stroke hospitals between 2003 and 2012. We used multivariable logistic regression models to identify hospital-level and patient-level predictors of NIHSS documentation. We examined the relationship between hospital-level NIHSS documentation rates and observed NIHSS scores to determine whether the reporting of NIHSS data was subject to selection bias. The overall NIHSS documentation rate was 56.1%; the median NIHSS was 4 (interquartile range, 2-9). Between 2003 and 2012, mean hospital-level NIHSS documentation increased dramatically from 27% to 70% (P

Original languageEnglish (US)
Pages (from-to)S90-S98
JournalCirculation: Cardiovascular Quality and Outcomes
Issue number6_suppl_3
StatePublished - Oct 1 2015


  • documentation
  • hospitals
  • registries
  • selection bias
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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