Background: 

Perioperative stroke is associated with high rates of morbidity and mortality, yet there is no validated screening tool. The modified National Institutes of Health Stroke Scale (mNIHSS) is validated for use in nonsurgical strokes but is not well-studied in surgical patients. We evaluated perioperative changes in the mNIHSS score in noncardiac, non-neurological surgery patients, feasibility in the perioperative setting, and the relationship between baseline cognitive screening and change in mNIHSS score.

Methods: 

Patients aged 65 years and above presenting for noncardiac, non-neurological surgery were prospectively recruited. Those with significant preoperative cognitive impairment (Montreal Cognitive Assessment score [MoCA] ≤17) were excluded. mNIHSS was assessed preoperatively, on postoperative day (POD) 0, POD 1, and POD 2, demographic data collected, and feedback solicited from participants. Changes in mNIHSS from baseline, time to completion, and relationship between baseline MoCA score and change in mNIHSS score were analyzed.

Results: 

Twenty-five patients were enrolled into the study; no overt strokes occurred. Median mNIHSS score increased between baseline (0 interquartile range [IQR 0 to 1]) and POD 0 (2 [IQR 0 to 3.5]; P<0.001) but not between baseline and POD 1 (0.5 [IQR 0 to 1.5]; P=0.174) or POD 2 (0 [IQR 0 to 1]; P=0.650). Time to complete the mNIHSS at baseline was 3.5 minutes (SD 0.8), increasing to 4.1 minutes (SD 1.0) on POD 0 (P=0.0249). Baseline MoCA score was correlated with mNIHSS score change (P=0.038). Perioperative administration of the mNIHSS was feasible, and acceptable to patients.

Conclusions: 

Changes in mNIHSS score can occur early after surgery in the absence of overt stroke. Assessment of mNIHSS appears feasible in the perioperative setting, although further research is required to define its role in detecting perioperative stroke.

中文翻译：

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非心脏手术后使用改良的国立卫生研究院卒中量表进行术后筛查：一项初步研究

背景： 

围手术期卒中与高发病率和死亡率相关，但尚无经过验证的筛查工具。修改后的美国国立卫生研究院卒中量表 (mNIHSS) 经验证可用于非手术卒中，但尚未在外科患者中得到充分研究。我们评估了非心脏、非神经外科手术患者 mNIHSS 评分的围手术期变化、围手术期的可行性以及基线认知筛查与 mNIHSS 评分变化之间的关系。

方法： 

前瞻性招募了 65 岁及以上接受非心脏、非神经外科手术的患者。排除有显着术前认知障碍（蒙特利尔认知评估评分 [MoCA] ≤17）的患者。mNIHSS 在术前、术后第 0 天 (POD) 0、POD 1 和 POD 2 进行评估，收集人口统计数据，并征求参与者的反馈。分析了 mNIHSS 从基线的变化、完成时间以及基线 MoCA 评分与 mNIHSS 评分变化之间的关系。

结果： 

25 名患者参加了该研究；没有发生明显的中风。中位 mNIHSS 评分在基线（0 四分位距 [IQR 0 到 1]）和 POD 0（2 [IQR 0 到 3.5]；P <0.001）之间增加，但在基线和 POD 1（0.5 [IQR 0 到 1.5]；P =0.174）或 POD 2（0 [IQR 0 到 1]；P =0.650）。基线时完成 mNIHSS 的时间为 3.5 分钟 (SD 0.8)，在 POD 0 ( P = 0.0249)时增加到 4.1 分钟 (SD 1.0 )。基线 MoCA 评分与 mNIHSS 评分变化相关（P = 0.038）。mNIHSS 的围手术期管理是可行的，并且患者可以接受。

结论： 

在没有明显中风的情况下，mNIHSS 评分的变化可以在手术后早期发生。mNIHSS 的评估在围手术期似乎是可行的，尽管需要进一步的研究来确定其在围手术期卒中检测中的作用。