# Pediatric NIH Stroke Scale

PedNIHSS

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/pediatric_nihss`
HTML: https://magentlab.com/docs/pediatric-nihss
Markdown: https://magentlab.com/docs/pediatric-nihss.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Sum Ichord 2011 PedNIHSS points from 15 caller-assigned NINDS NIH Stroke Scale integers, with left and right motor arm and leg. Does not apply total-score severity bands.

## When to use

When an agent already has Ichord 2011 PedNIHSS integers and needs that published total. magent does not examine the child, score Brott 1989 15-item NIHSS, score mNIHSS, or issue a tPA order.

## When not to use

- Not a medical device. magent does not examine the child. Each item is a caller-assigned Ichord 2011 / NINDS integer. Not a diagnosis.
- This is the Ichord 2011 pediatric adaptation of the NINDS NIH Stroke Scale: all examination items and scoring ranges retained, with left and right motor arm and leg (each 0-4) and visual 0-3. It is not the Brott 1989 15-item NIHSS (weaker-limb motor, pupillary response, plantar reflex, max 37). Not mNIHSS. Not a tPA order.
- Ichord 2011 published no total-score mild/moderate/severe cutoffs. This tool returns score and max_score only. It does not apply later 5/15/20 website cuts.

## Formula

```
PedNIHSS = loc (0-3) + loc_questions (0-2) + loc_commands (0-2) + best_gaze (0-2) + best_visual (0-3) + facial_palsy (0-3) + motor_left_arm (0-4) + motor_right_arm (0-4) + motor_left_leg (0-4) + motor_right_leg (0-4) + limb_ataxia (0-2) + sensory (0-2) + best_language (0-3) + dysarthria (0-2) + extinction (0-2); Ichord 2011 pediatric adaptation of the NINDS NIHSS item list and scoring ranges (L/R motor; no pupillary response or plantar reflex); total = sum; max 42; no published total-score severity bands
```

## Citation

[Interrater Reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a Multicenter Study](https://doi.org/10.1161/STROKEAHA.110.607192)
Ichord RN, Bastian R, Abraham L, et al.
Stroke. 2011;42(3):613-617
DOI: [10.1161/STROKEAHA.110.607192](https://doi.org/10.1161/STROKEAHA.110.607192)

## Worked example

### All items at published minimum

Given: `best_gaze=0, best_language=0, best_visual=0, dysarthria=0, extinction=0, facial_palsy=0, limb_ataxia=0, loc=0, loc_commands=0, loc_questions=0, motor_left_arm=0, motor_left_leg=0, motor_right_arm=0, motor_right_leg=0, sensory=0`

1. loc, loc_questions, loc_commands, best_gaze, best_visual, facial_palsy, motor_left_arm, motor_right_arm, motor_left_leg, motor_right_leg, limb_ataxia, sensory, best_language, dysarthria, and extinction are 0 as assigned by the caller
2. Score = 0 (max 42). Ichord 2011 published no total-score severity band.


### All items at published maximum

Given: `best_gaze=2, best_language=3, best_visual=3, dysarthria=2, extinction=2, facial_palsy=3, limb_ataxia=2, loc=3, loc_commands=2, loc_questions=2, motor_left_arm=4, motor_left_leg=4, motor_right_arm=4, motor_right_leg=4, sensory=2`

1. each Ichord 2011 PedNIHSS item is at that paper's published NINDS maximum as assigned by the caller
2. Score = 42 (max 42). No total-score severity band.


## Also searched as

- Pediatric NIH Stroke Scale
- PedNIHSS
- Ichord 2011 PedNIHSS
- Pediatric National Institutes of Health Stroke Scale
- pediatric NIHSS
- Ped NIHSS
- childhood NIH stroke scale
- NINDS pediatric NIHSS

## Parameters

- `loc` (integer, required): Caller-assigned Ichord 2011 PedNIHSS level of consciousness (integer 0-3): 0 alert, 1 not alert but arousable, 2 not alert requires repeated stimulation, 3 unresponsive. magent does not examine the child.
- `loc_questions` (integer, required): Caller-assigned Ichord 2011 PedNIHSS LOC questions (integer 0-2): 0 answers both correctly, 1 answers one correctly, 2 incorrect. magent does not examine the child.
- `loc_commands` (integer, required): Caller-assigned Ichord 2011 PedNIHSS LOC commands (integer 0-2): 0 obeys both correctly, 1 obeys one correctly, 2 incorrect. magent does not examine the child.
- `best_gaze` (integer, required): Caller-assigned Ichord 2011 PedNIHSS best gaze (integer 0-2): 0 normal, 1 partial gaze palsy, 2 forced deviation. magent does not examine the child.
- `best_visual` (integer, required): Caller-assigned Ichord 2011 PedNIHSS best visual, NINDS range (integer 0-3): 0 no visual loss, 1 partial hemianopia, 2 complete hemianopia, 3 bilateral hemianopia. Not Brott 0-2. magent does not examine the child.
- `facial_palsy` (integer, required): Caller-assigned Ichord 2011 PedNIHSS facial palsy (integer 0-3): 0 normal, 1 minor, 2 partial, 3 complete. magent does not examine the child.
- `motor_left_arm` (integer, required): Caller-assigned Ichord 2011 PedNIHSS left arm motor, NINDS style (integer 0-4): 0 no drift, 1 drift, 2 some effort against gravity, 3 no effort against gravity, 4 no movement. Not Brott weaker-limb. magent does not examine the child.
- `motor_right_arm` (integer, required): Caller-assigned Ichord 2011 PedNIHSS right arm motor, NINDS style (integer 0-4): 0 no drift, 1 drift, 2 some effort against gravity, 3 no effort against gravity, 4 no movement. Not Brott weaker-limb. magent does not examine the child.
- `motor_left_leg` (integer, required): Caller-assigned Ichord 2011 PedNIHSS left leg motor, NINDS style (integer 0-4): 0 no drift, 1 drift, 2 some effort against gravity, 3 no effort against gravity, 4 no movement. Not Brott weaker-limb. magent does not examine the child.
- `motor_right_leg` (integer, required): Caller-assigned Ichord 2011 PedNIHSS right leg motor, NINDS style (integer 0-4): 0 no drift, 1 drift, 2 some effort against gravity, 3 no effort against gravity, 4 no movement. Not Brott weaker-limb. magent does not examine the child.
- `limb_ataxia` (integer, required): Caller-assigned Ichord 2011 PedNIHSS limb ataxia (integer 0-2): 0 absent, 1 present in one limb, 2 present in two limbs. magent does not examine the child.
- `sensory` (integer, required): Caller-assigned Ichord 2011 PedNIHSS sensory (integer 0-2): 0 normal, 1 mild to moderate loss, 2 severe to total loss. magent does not examine the child.
- `best_language` (integer, required): Caller-assigned Ichord 2011 PedNIHSS best language (integer 0-3): 0 no aphasia, 1 mild to moderate, 2 severe aphasia, 3 mute or global aphasia. magent does not examine the child.
- `dysarthria` (integer, required): Caller-assigned Ichord 2011 PedNIHSS dysarthria (integer 0-2): 0 normal articulation, 1 mild to moderate, 2 severe or unintelligible. magent does not examine the child.
- `extinction` (integer, required): Caller-assigned Ichord 2011 PedNIHSS extinction and inattention (integer 0-2): 0 no abnormality, 1 inattention to one modality, 2 profound hemi-inattention or extinction to more than one modality. Not Brott neglect. magent does not examine the child.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/pediatric_nihss`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "best_gaze": "0",
      "best_language": "0",
      "best_visual": "0",
      "dysarthria": "0",
      "extinction": "0",
      "facial_palsy": "0",
      "limb_ataxia": "0",
      "loc": "0",
      "loc_commands": "0",
      "loc_questions": "0",
      "motor_left_arm": "0",
      "motor_left_leg": "0",
      "motor_right_arm": "0",
      "motor_right_leg": "0",
      "sensory": "0"
    },
    {
      "best_gaze": "0",
      "best_language": "0",
      "best_visual": "0",
      "dysarthria": "0",
      "extinction": "0",
      "facial_palsy": "0",
      "limb_ataxia": "0",
      "loc": "0",
      "loc_commands": "0",
      "loc_questions": "0",
      "motor_left_arm": "0",
      "motor_left_leg": "0",
      "motor_right_arm": "0",
      "motor_right_leg": "0",
      "sensory": "0"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/pediatric-nihss

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/pediatric_nihss",
  "items": [
    {
      "components": [
        {
          "value": 0,
          "factor": "loc",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "loc_questions",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "loc_commands",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "best_gaze",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "best_visual",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "facial_palsy",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "motor_left_arm",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "motor_right_arm",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "motor_left_leg",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "motor_right_leg",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "limb_ataxia",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "sensory",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "best_language",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "dysarthria",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "extinction",
          "points": 0,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Ichord RN, Bastian R, Abraham L, et al.",
        "doi": "10.1161/STROKEAHA.110.607192",
        "id": "ichord-2011",
        "pmid": "21317270",
        "source": "Stroke. 2011;42(3):613-617",
        "title": "Interrater Reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a Multicenter Study"
      },
      "formula": "pediatric_nihss",
      "formula_expression": "PedNIHSS = loc (0-3) + loc_questions (0-2) + loc_commands (0-2) + best_gaze (0-2) + best_visual (0-3) + facial_palsy (0-3) + motor_left_arm (0-4) + motor_right_arm (0-4) + motor_left_leg (0-4) + motor_right_leg (0-4) + limb_ataxia (0-2) + sensory (0-2) + best_language (0-3) + dysarthria (0-2) + extinction (0-2); Ichord 2011 pediatric adaptation of the NINDS NIHSS item list and scoring ranges (L/R motor; no pupillary response or plantar reflex); total = sum; max 42; no published total-score severity bands",
      "max_score": 42,
      "score": 0
    },
    {
      "components": [
        {
          "value": 0,
          "factor": "loc",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "loc_questions",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "loc_commands",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "best_gaze",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "best_visual",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "facial_palsy",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "motor_left_arm",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "motor_right_arm",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "motor_left_leg",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "motor_right_leg",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "limb_ataxia",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "sensory",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "best_language",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "dysarthria",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "extinction",
          "points": 0,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Ichord RN, Bastian R, Abraham L, et al.",
        "doi": "10.1161/STROKEAHA.110.607192",
        "id": "ichord-2011",
        "pmid": "21317270",
        "source": "Stroke. 2011;42(3):613-617",
        "title": "Interrater Reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a Multicenter Study"
      },
      "formula": "pediatric_nihss",
      "formula_expression": "PedNIHSS = loc (0-3) + loc_questions (0-2) + loc_commands (0-2) + best_gaze (0-2) + best_visual (0-3) + facial_palsy (0-3) + motor_left_arm (0-4) + motor_right_arm (0-4) + motor_left_leg (0-4) + motor_right_leg (0-4) + limb_ataxia (0-2) + sensory (0-2) + best_language (0-3) + dysarthria (0-2) + extinction (0-2); Ichord 2011 pediatric adaptation of the NINDS NIHSS item list and scoring ranges (L/R motor; no pupillary response or plantar reflex); total = sum; max 42; no published total-score severity bands",
      "max_score": 42,
      "score": 0
    }
  ]
}
```

## Response fields

- `formula` (string): pediatric_nihss
- `formula_expression` (string): Exact expression used
- `score` (integer): Ichord 2011 PedNIHSS sum of 15 caller-assigned NINDS examination items (0-42)
- `max_score` (integer): Always 42
- `components` (array): Per-item caller-assigned points
- `citation` (object): Ichord Stroke 2011 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "value": 0,
      "factor": "loc",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "loc_questions",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "loc_commands",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "best_gaze",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "best_visual",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "facial_palsy",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "motor_left_arm",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "motor_right_arm",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "motor_left_leg",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "motor_right_leg",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "limb_ataxia",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "sensory",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "best_language",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "dysarthria",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "extinction",
      "points": 0,
      "present": true
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Ichord RN, Bastian R, Abraham L, et al.",
    "doi": "10.1161/STROKEAHA.110.607192",
    "id": "ichord-2011",
    "pmid": "21317270",
    "source": "Stroke. 2011;42(3):613-617",
    "title": "Interrater Reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a Multicenter Study"
  },
  "formula": "pediatric_nihss",
  "formula_expression": "PedNIHSS = loc (0-3) + loc_questions (0-2) + loc_commands (0-2) + best_gaze (0-2) + best_visual (0-3) + facial_palsy (0-3) + motor_left_arm (0-4) + motor_right_arm (0-4) + motor_left_leg (0-4) + motor_right_leg (0-4) + limb_ataxia (0-2) + sensory (0-2) + best_language (0-3) + dysarthria (0-2) + extinction (0-2); Ichord 2011 pediatric adaptation of the NINDS NIHSS item list and scoring ranges (L/R motor; no pupillary response or plantar reflex); total = sum; max 42; no published total-score severity bands",
  "max_score": 42,
  "score": 0
}
```

## Errors

- HTTP 400 `invalid_pediatric_nihss`: PedNIHSS needs Ichord pediatric NIH Stroke Scale item scores in published ranges. Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [NIHSS](https://magentlab.com/docs/nihss) — Sum Brott 1989 NIH stroke scale points from 15 caller-assigned examination integers, including pupillary response and plantar reflex. Weaker-limb motor arm and leg. Does not apply later total-score severity bands.
- [mNIHSS](https://magentlab.com/docs/mnihss) — Sum Meyer/Lyden 2001 modified NIH stroke scale points from 11 caller-assigned NINDS-style examination integers, with left/right motor and sensory collapsed to 0-1. Does not apply total-score severity bands.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.