Spanish cross-cultural adaptation and validation of the National Institutes of Health Stroke Scale

Raúl Domínguez, José F. Vila, Federico Augustovski, Vilma Irazola, Pablo R. Castillo, Roberto Rotta Escalante, Thomas G. Brott, James F. Meschia

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


OBJECTIVES: To adapt and validate a Spanish-language version (SV) of the National institutes of Health Stroke Scale (NIHSS) to facilitate its use in Spanish-speaking contexts. PATIENTS AND METHODS: The methods recommended by the International Quality of Life Assessment Project were followed. Two forward translations and 1 back translation of the NIHSS were developed to ensure lingual and cultural equivalence. A final revised SV-NIHSS was administered by 8 physicians to patients with stroke in 3 clinics in Buenos Aires, Argentina, from September 2003 to December 2003. RESULTS: The study included 102 patients (mean ± SD age, 73.3±6.5 years; 56% women) with stroke (86% ischemic). The SV-NIHSS mean baseline score was 9.78±7.04. Interrater reliability was independently evaluated for 98 patients, showing a high agreement: κ, 0.77 to 0.99 for the 15 items; interrater correlation coefficient, 0.991 (95% confidence interval, 0.987-0.994). Intrarater reliability was excellent: κ, 0.86 to 1.00 for the 15 items; mean intrarater correlation coefficient, 0.994 (95% confidence interval, 0.991-0.996). Construct validity was also adequate; the SV-NIHSS had a negative correlation with baseline Glasgow Coma Scale (Spearman coefficient = -0.574, P<.001) and with Barthel Index at 3 months (Spearman coefficient = -0.658, P<.001). Patients with different Rankin scores at 3 months also had significantly different baseline SV-NIHSS scores, from a mean of 4.29±2.21 for Rankin score of 0 to a mean of 29.40±3.97 for Rankin score of 6 (P<.001). CONCLUSION: This study shows that a Spanish-language version of the NIHSS developed with internationally recommended methods is reliable and valid when applied in a Spanish-speaking setting.

Original languageEnglish (US)
Pages (from-to)476-480
Number of pages5
JournalMayo Clinic proceedings
Issue number4
StatePublished - Apr 2006

ASJC Scopus subject areas

  • General Medicine


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