Utility of Items of Baseline National Institutes of Health Stroke Scale as Predictors of Functional Outcomes at Three Months after Mild Ischemic Stroke

CRCS-5 Investigators

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits is crucial in decision making regarding thrombolytic therapy. We examined the utility of individual National Institutes of Health Stroke Scale (NIHSS) score items or clusters of items as predictors of functional outcomes at 3 months after mild stroke. Methods Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had baseline NIHSS scores less than or equal to 5. Functional outcomes at 3 months were dichotomized as favorable (modified RankinScale [mRS] score 0 or 1) or unfavorable (mRS 2-6). Individual NIHSS items, clusters of items, and the total score were tested for their ability to predict outcomes in multivariable models. Area under the receiver operating characteristic curve (AUC) was used to assess model performance. Results Of the 2209 patients who met eligibility criteria, 588 (26.6%) exhibited unfavorable functional outcomes at 3 months. Of the 15 items of the NIHSS, all except item 8 (sensory) and item 11 (extinction) were significantly associated with unfavorable functional outcomes in bivariate analysis (P's < .05). Among the multivariable models, the model with the total NIHSS score exhibited an AUC similar to that of the model with all NIHSS items in predicting functional outcomes (.758 [95% confidence interval .739-.775] versus .759 [.740-.776]; P = .75 for pairwise comparison). Conclusions Simply using the total NIHSS score was as effective as using all individual items in predicting outcomes of mild stroke patients.

Original languageEnglish
Pages (from-to)1306-1313
Number of pages8
JournalJournal of Stroke and Cerebrovascular Diseases
Volume26
Issue number6
DOIs
Publication statusPublished - 2017 Jun 1

Fingerprint

National Institutes of Health (U.S.)
Stroke
Area Under Curve
Aptitude
Thrombolytic Therapy
Neurologic Manifestations
ROC Curve
Registries
Decision Making
Databases
Confidence Intervals

Keywords

  • Mild stroke
  • NIHSS
  • outcome assessment
  • prognosis

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

@article{673be91f1ba14747b54fd30031ab0578,
title = "Utility of Items of Baseline National Institutes of Health Stroke Scale as Predictors of Functional Outcomes at Three Months after Mild Ischemic Stroke",
abstract = "Background Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits is crucial in decision making regarding thrombolytic therapy. We examined the utility of individual National Institutes of Health Stroke Scale (NIHSS) score items or clusters of items as predictors of functional outcomes at 3 months after mild stroke. Methods Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had baseline NIHSS scores less than or equal to 5. Functional outcomes at 3 months were dichotomized as favorable (modified RankinScale [mRS] score 0 or 1) or unfavorable (mRS 2-6). Individual NIHSS items, clusters of items, and the total score were tested for their ability to predict outcomes in multivariable models. Area under the receiver operating characteristic curve (AUC) was used to assess model performance. Results Of the 2209 patients who met eligibility criteria, 588 (26.6{\%}) exhibited unfavorable functional outcomes at 3 months. Of the 15 items of the NIHSS, all except item 8 (sensory) and item 11 (extinction) were significantly associated with unfavorable functional outcomes in bivariate analysis (P's < .05). Among the multivariable models, the model with the total NIHSS score exhibited an AUC similar to that of the model with all NIHSS items in predicting functional outcomes (.758 [95{\%} confidence interval .739-.775] versus .759 [.740-.776]; P = .75 for pairwise comparison). Conclusions Simply using the total NIHSS score was as effective as using all individual items in predicting outcomes of mild stroke patients.",
keywords = "Mild stroke, NIHSS, outcome assessment, prognosis",
author = "{CRCS-5 Investigators} and Choi, {Jay Chol} and Kim, {Beom Joon} and Han, {Moon Ku} and Lee, {Soo Joo} and Kyusik Kang and Park, {Jong Moo} and Park, {Sang Soon} and Park, {Tai Hwan} and Cho, {Yong Jin} and Hong, {Keun Sik} and Lee, {Kyung Bok} and Jun Lee and Ryu, {Wi Sun} and Kim, {Dong Eog} and Nah, {Hyun Wook} and Kim, {Dae Hyun} and Cha, {Jae Kwan} and Kim, {Joon Tae} and Choi, {Kang Ho} and Oh, {Mi Sun} and Yu, {Kyung Ho} and Lee, {Byung Chul} and Jang, {Myung Suk} and Lee, {Ji Sung} and Juneyoung Lee and Bae, {Hee Joon}",
year = "2017",
month = "6",
day = "1",
doi = "10.1016/j.jstrokecerebrovasdis.2017.01.027",
language = "English",
volume = "26",
pages = "1306--1313",
journal = "Journal of Stroke and Cerebrovascular Diseases",
issn = "1052-3057",
publisher = "W.B. Saunders Ltd",
number = "6",

}

TY - JOUR

T1 - Utility of Items of Baseline National Institutes of Health Stroke Scale as Predictors of Functional Outcomes at Three Months after Mild Ischemic Stroke

AU - CRCS-5 Investigators

AU - Choi, Jay Chol

AU - Kim, Beom Joon

AU - Han, Moon Ku

AU - Lee, Soo Joo

AU - Kang, Kyusik

AU - Park, Jong Moo

AU - Park, Sang Soon

AU - Park, Tai Hwan

AU - Cho, Yong Jin

AU - Hong, Keun Sik

AU - Lee, Kyung Bok

AU - Lee, Jun

AU - Ryu, Wi Sun

AU - Kim, Dong Eog

AU - Nah, Hyun Wook

AU - Kim, Dae Hyun

AU - Cha, Jae Kwan

AU - Kim, Joon Tae

AU - Choi, Kang Ho

AU - Oh, Mi Sun

AU - Yu, Kyung Ho

AU - Lee, Byung Chul

AU - Jang, Myung Suk

AU - Lee, Ji Sung

AU - Lee, Juneyoung

AU - Bae, Hee Joon

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits is crucial in decision making regarding thrombolytic therapy. We examined the utility of individual National Institutes of Health Stroke Scale (NIHSS) score items or clusters of items as predictors of functional outcomes at 3 months after mild stroke. Methods Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had baseline NIHSS scores less than or equal to 5. Functional outcomes at 3 months were dichotomized as favorable (modified RankinScale [mRS] score 0 or 1) or unfavorable (mRS 2-6). Individual NIHSS items, clusters of items, and the total score were tested for their ability to predict outcomes in multivariable models. Area under the receiver operating characteristic curve (AUC) was used to assess model performance. Results Of the 2209 patients who met eligibility criteria, 588 (26.6%) exhibited unfavorable functional outcomes at 3 months. Of the 15 items of the NIHSS, all except item 8 (sensory) and item 11 (extinction) were significantly associated with unfavorable functional outcomes in bivariate analysis (P's < .05). Among the multivariable models, the model with the total NIHSS score exhibited an AUC similar to that of the model with all NIHSS items in predicting functional outcomes (.758 [95% confidence interval .739-.775] versus .759 [.740-.776]; P = .75 for pairwise comparison). Conclusions Simply using the total NIHSS score was as effective as using all individual items in predicting outcomes of mild stroke patients.

AB - Background Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits is crucial in decision making regarding thrombolytic therapy. We examined the utility of individual National Institutes of Health Stroke Scale (NIHSS) score items or clusters of items as predictors of functional outcomes at 3 months after mild stroke. Methods Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had baseline NIHSS scores less than or equal to 5. Functional outcomes at 3 months were dichotomized as favorable (modified RankinScale [mRS] score 0 or 1) or unfavorable (mRS 2-6). Individual NIHSS items, clusters of items, and the total score were tested for their ability to predict outcomes in multivariable models. Area under the receiver operating characteristic curve (AUC) was used to assess model performance. Results Of the 2209 patients who met eligibility criteria, 588 (26.6%) exhibited unfavorable functional outcomes at 3 months. Of the 15 items of the NIHSS, all except item 8 (sensory) and item 11 (extinction) were significantly associated with unfavorable functional outcomes in bivariate analysis (P's < .05). Among the multivariable models, the model with the total NIHSS score exhibited an AUC similar to that of the model with all NIHSS items in predicting functional outcomes (.758 [95% confidence interval .739-.775] versus .759 [.740-.776]; P = .75 for pairwise comparison). Conclusions Simply using the total NIHSS score was as effective as using all individual items in predicting outcomes of mild stroke patients.

KW - Mild stroke

KW - NIHSS

KW - outcome assessment

KW - prognosis

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U2 - 10.1016/j.jstrokecerebrovasdis.2017.01.027

DO - 10.1016/j.jstrokecerebrovasdis.2017.01.027

M3 - Article

C2 - 28318959

AN - SCOPUS:85015296554

VL - 26

SP - 1306

EP - 1313

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

IS - 6

ER -