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Stroke. 2015 Oct;46(10):2779-85. doi: 10.1161/STROKEAHA.115.010380. Epub 2015 Sep 10.

National Institutes of Health Stroke Scale Item Profiles as Predictor of Patient Outcome: External Validation on Safe Implementation of Thrombolysis in Stroke-Monitoring Study Data.

Author information

1
From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., R.L.F., K.R.L.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Centre, OH (H.S.); and Department of Neurology, University of Cincinnati College of Medicine, OH (D.K., P.K., J.P.B.). Azmil.Abdul-Rahim@glasgow.ac.uk.
2
From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., R.L.F., K.R.L.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Centre, OH (H.S.); and Department of Neurology, University of Cincinnati College of Medicine, OH (D.K., P.K., J.P.B.).

Abstract

BACKGROUND AND PURPOSE:

National Institutes of Health Stroke Scale (NIHSS) item profiles that were recently proposed and validated may prove useful for clinical prognostication and research studies. We aimed to validate the NIHSS item profiles in hyper-acute stroke patients who received thrombolysis treatment (tissue-type plasminogen activator).

METHODS:

We applied the latent class analysis probabilities of the profile membership generated from the derivation study onto NIHSS data from the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST). We separately considered NIHSS data collected within 3 hours and at ≈24 hours after stroke onset to obtain 2 sets of symptom groupings. The discrimination and calibration of both sets of symptom profiles were assessed from their association with outcomes. The outcome measures included modified Rankin Scale (mRS; using full distribution and dichotomized, mRS 0-1 or back to baseline) at day 90 and mortality by 90 days.

RESULTS:

We obtained data for 6843 patients. Ordinal analysis of mRS showed odds of better outcome across the profiles, for each set of symptom profiles, adjusted for age, sex, and prestroke mRS. Dichotomized outcomes mirrored the ordinal findings. There were significant differences in prognostic discrimination ability for the dichotomized outcome measures between the 2 sets of symptom profiles, with the latter set (ie, 24-hour symptom profiles) performing better.

CONCLUSIONS:

The NIHSS item profiles are individually associated with functional outcome and mortality in acute stroke patients treated with tissue-type plasminogen activator. Considering profiles of NIHSS subscores rather than only the total score is informative for prognostication, particularly for assessments collected 24 hours after stroke onset.

KEYWORDS:

outcome assessment; prognosis; stroke; thrombolytic therapy; tissue-type plasminogen activator

PMID:
26359360
DOI:
10.1161/STROKEAHA.115.010380
[Indexed for MEDLINE]

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