Validation of minor stroke definitions for thrombolysis decision making

Tai Hwan Park, Keun Sik Hong, Jay Chol Choi, Pamela Song, Ji Sung Lee, Juneyoung Lee, Jong Moo Park, Kyusik Kang, Kyung Bok Lee, Yong Jin Cho, Gustavo Saposnik, Moon Ku Han, Hee Joon Bae

    Research output: Contribution to journalArticlepeer-review

    24 Citations (Scopus)

    Abstract

    Background: Patients with low National Institutes of Health Stroke Scale (NIHSS) scores are frequently excluded from thrombolysis, but more than 25% of them remain disabled. We sought to define a validated minor stroke definition to reduce the inappropriate treatment exclusion. Methods: From an outcome database, untreated patients with an NIHSS score of 5 or less presenting within a 4.5-hour window were identified and 3-month modified Rankin Scale (mRS) outcomes were analyzed according to individual isolated symptoms and total NIHSS scores. The validity of the following minor stroke definitions were assessed: (1) the National Institute of Neurological Disorders and Stroke Tissue Plasminogen Activator (NINDS-TPA) trials' definition, (2) the total NIHSS score, varying a cutoff point from 0 to 4, and (3) our proposed definition that included an NIHSS score = 0 or an NIHSS score = 1 on the items of level of consciousness (LOC), gaze, facial palsy, sensory, or dysarthria. Results: Of 647 patients, 172 patients (26.6%) had a 3-month unfavorable outcome (mRS score 2-6). Favorable outcome was achieved in more than 80% of patients with an NIHSS score of 1 or less or with an isolated symptom on the LOC, gaze, facial palsy, sensory, or dysarthria item. In contrast, unfavorable outcome proportion was more than 25% in patients with an NIHSS score of 2 or more. When the NINDS-TPA trials' definition, our definition, or the definition of an NIHSS score of 1 or less were applied, more than 75% of patients with an unfavorable outcome were defined as a non-minor stroke and less than 15% of patients with an unfavorable outcome were defined as a minor stroke. Conclusion: Implementation of an optimal definition of minor stroke into thrombolysis decision-making process would decrease the unfavorable outcomes in patients with low NIHSS scores.

    Original languageEnglish
    Pages (from-to)482-490
    Number of pages9
    JournalJournal of Stroke and Cerebrovascular Diseases
    Volume22
    Issue number4
    DOIs
    Publication statusPublished - 2013

    Keywords

    • Minor stroke definition
    • NINDS-TPA trials
    • acute ischemic stroke
    • outcome
    • thrombolysis

    ASJC Scopus subject areas

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

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