Content » Vol 48, Issue 10

Short communication

The Scandinavian Stroke Scale is equally as good as The National Institutes of Health Stroke Scale in identifying 3-month outcome

Torunn Askim, Julie Bernhardt, Leonid Churilov, Bent Indredavik
Department of Neuroscience, NTNU, Faculty of Medicine, Postbox 8905 , NO-7491 Trondheim, Norway. E-mail:
DOI: 10.2340/16501977-2155


Background: The National Institutes of Health Stroke Scale (NIHSS) is the first choice among stroke scales. The Scandinavian Stroke Scale (SSS) is an alternative scale that is easy to apply in the clinic.
Aim: To compare the ability of the SSS with that of the NIHSS in identifying patients who are dead or dependent at 3-month follow-up.
Methods: A prospective study including patients with acute stroke. NIHSS and SSS measurements were obtained during index hospital stay. The receiver operating characteristics curve was used to determine the optimal dichotomization of the NIHSS and the SSS by using a modified Rankin Scale (mRS) >2 at 3-month follow-up as the criterion standard. Positive and negative predictive values (PPV and NPV) were calculated.
Results: A total of 104 patients (mean age 79 years, 57. 7% men) were included. Median (interquartile range (IQR)) NIHSS and SSS score were 6. 0 (2. 0–11. 8) and 43. 5 (30. 0–51. 0), respectively. The areas under the curve were 0. 769 and 0. 796 for NIHSS and SSS, respectively, χ2 (p = 0. 303). The best cut-off point for NIHSS was 6/7 points (PPV = 76. 2%, NPV = 69. 0%) while for SSS it was 42/43 points (PPV = 71. 4%, NPV = 73. 2%).
Conclusion: The SSS was as good as the NIHSS in identifying patients who had died or were dependent at 3-month follow-up. The measurement properties of the SSS should be investigated further.

Lay Abstract


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