Performance Measurement Network

Question: Transfer in patients that are intubated

Can we use the NIHSS from an outside facility, if the patient is being transferred to our facility for IA, MER? In particular, when the patient is intubated, they are always sedated, making it impossible for us to do a new NIHSS prior to treatment. Will this still count as a passing of CSTK-5 if the patient has a hemorrhagic transformation, and an increase in NIHSS of 4 or more points?


For CSTK-01 NIHSS Performed for Ischemic Stroke, a HNIHSS score must be done *at your hospital* prior to IA/MER to meet this measure. (Please see the data element definition for "Initial NIHSS Score Performed" The NIHSS score done at the transferring hospital does not count. If a NIHSS is not done at your hospital, select "NO" for "Initial NIHSS Score Performed". There is no exclusion for patients who are intubated, etc.

For CSTK-05, Hemorrhagic Transformation, "NIHSS Score Documented Closest to IA t-PA or MER Initiation" (please refer to this data element definition), if the only score documented prior to IA t-PA or MER at your hospital was the NIHSS done at the transferring hospital, then enter that score to answer this data element. Notes for abstraction state: If only one NIHSS score is documented prior to IA t-PA or MER initiation and no other score(s)are available for comparison, enter the value for that score.

Please see the data element definitions in the July 2015 update to the Comprehensive Stroke Implementation Guide for complete abstraction notes and guidelines.

Hope this clarifies for you. Thank you for your inquiry.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: CSTK-01, NIHSS Score Documented Closest to IA t-PA or MER Initiation,
Manual: Current Manual (current data collection period; prior to data transmission)

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