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Objectives This study aims to evaluate the diagnostic performance of NIHSS  extinction and inattention  item, compared to the results of the Oxford Cognitive Screen (OCS) heart subtest. Additionally, the possible role of the NIHSS  visual field  subtest on the NIHSS  extinction and inattention  subtest performance is explored and discussed. Methods We analysed scores on NIHSS  extinction and inattention  subtest, NIHSS  visual field  subtest, and OCS  heart subtest  on a sample of 118 post-stroke patients. Results Compared to OCS heart subtest, the results on NIHSS  extinction and inattention  subtest showed an accuracy of 72.9% and a moderate agreement level (Cohen’s kappa = 0.404). Furthermore, a decrease in NIHSS accuracy detecting neglect (61.1%) was observed in patients with pathological scores in NIHSS  visual field  item. Conclusions Extreme caution is recommended for the diagnostic performance of  extinction and inattention  item of NIHSS. Signs of neglect may not be detected by NIHSS, and may be confused with visual field impairment. Trial registration This study refers to an observational study protocol submitted to  ClinicalTrials.gov  with identifier:  NCT03968627 . The name of the registry is “Development of a National Protocol for Stroke Rehabilitation in a Multicenter Italian Institution” and the date of the registration is the 30th May 2019.

Critical issue on the extinction and inattention subtest of NIHSS scale: an analysis on post-acute stroke patients attending inpatient rehabilitation