{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:00:39Z","timestamp":1787065239192,"version":"build-2736575974"},"reference-count":29,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2015,12,19]]},"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>Most patients with stroke-like symptoms screened by advanced imaging for proximal occlusion will not have a thrombus accessible by neurointerventional techniques. Development of a sensitive clinical scoring system for rapidly identifying patients with an emergent large vessel occlusion could help target limited resources and reduce exposure to unnecessary imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This historical cohort study included patients who underwent non-contrast CT and CT angiography in the emergency department for stroke-like symptoms. NIH Stroke Scale (NIHSS) criteria were extended to include resolved symptoms and dichotomized as present or absent. Combinations of NIHSS criteria were considered as tests for proximal occlusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Proximal cerebral vascular occlusion was present in 19.2% (100\/522) of the population and, of these, 13% (13\/100) had an NIHSS score of 0. The presence on examination or history of diminished consciousness with inability to answer questions, leg weakness, dysarthria, or gaze deviation had 96% sensitivity and 39% specificity for proximal occlusion. If implemented in this population, the use of CT angiography would have been decreased by 32.4% (169\/522 patients) while missing 0.76% with proximal occlusions (4\/522). Half of those missed (2\/4) would have been identified as large vessel infarcts on non-contrast CT, while the remainder (2\/4) were transient ischemic attacks associated with carotid stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this cohort, specific NIHSS criteria were highly sensitive for emergent large vessel occlusion and, if validated, may allow for clinical screening prior to advanced imaging with CT angiography.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/neurintsurg-2015-012088","type":"journal-article","created":{"date-parts":[[2016,1,15]],"date-time":"2016-01-15T07:57:42Z","timestamp":1452844662000},"page":"1208-1210","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Revisiting the NIH Stroke Scale as a screening tool for proximal vessel occlusion: can advanced imaging be targeted in acute stroke?"],"prefix":"10.1136","volume":"8","author":[{"given":"Ryan D","family":"Moore","sequence":"first","affiliation":[{"name":"Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila L","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven D","family":"Quarfordt","sequence":"additional","affiliation":[{"name":"Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blaise W","family":"Baxter","sequence":"additional","affiliation":[{"name":"Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,1,14]]},"reference":[{"key":"2025092910561046000_8.12.1208.1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000258112.14918.24"},{"key":"2025092910561046000_8.12.1208.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60491-6"},{"key":"2025092910561046000_8.12.1208.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.3058"},{"key":"2025092910561046000_8.12.1208.4","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.555664"},{"key":"2025092910561046000_8.12.1208.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31823ac046"},{"key":"2025092910561046000_8.12.1208.6","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.20.7.864"},{"key":"2025092910561046000_8.12.1208.7","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.27.10.1817"},{"key":"2025092910561046000_8.12.1208.8","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.53.1.126"},{"key":"2025092910561046000_8.12.1208.9","doi-asserted-by":"publisher","DOI":"10.1159\/000057847"},{"key":"2025092910561046000_8.12.1208.10","first-page":"238","article-title":"Relationships between angiographic findings and National Institutes of Health stroke scale score in cases of hyperacute carotid ischemic stroke","volume":"25","author":"Nakajima","year":"2004","journal-title":"Am J Neuroradiol"},{"key":"2025092910561046000_8.12.1208.11","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000182099.04994.fc"},{"key":"2025092910561046000_8.12.1208.12","first-page":"246","article-title":"Arterial occlusion revealed by CT angiography predicts NIH stroke score and acute outcomes after IV tPA treatment","volume":"26","author":"Sims","year":"2005","journal-title":"Am J Neuroradiol"},{"key":"2025092910561046000_8.12.1208.13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1411587"},{"key":"2025092910561046000_8.12.1208.14","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.30.8.1534"},{"key":"2025092910561046000_8.12.1208.15","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.31.4.858"},{"key":"2025092910561046000_8.12.1208.16","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.3.656"},{"key":"2025092910561046000_8.12.1208.17","unstructured":"Kochanek KD , Murphy SL , Xu J , et al . 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