A new prognostic scale for the early prediction of ischemic stroke recovery mainly based on traditional Chinese medicine symptoms and NIHSS score: a retrospective cohort study

Abstract

BackgroundIschemic stroke (IS) is a common disease, often resulting in death or disability. Previous studies on prognosis of stroke mainly focused on the baseline condition or modern expensive tests. However, the change of clinical symptoms during acute stage is considerably neglected. In our study, we aim to develop a new prognostic scale to predict the 90-day outcome of IS patients.MethodsIn this retrospective cohort study, a secondary data analysis was performed on 489 patients extracted from 1046 patients of 4 hospitals. A new prognostic scale was constructed to predict the recovery of IS mainly based on the National Institutes of Health Stroke Scale (NIHSS) score, traditional Chinese Medicine (TCM) symptoms & signs and the changes during the first 3 days of patients in the 3 TCM hospitals. Receiver Operating Characteristic (ROC) curve was used to determine the cutoff point for prediction. In the end, the scale was used to test the outcome of IS patients in Xuanwu hospital.ResultsThe new prognostic scale was composed of 8 items including age degree (OR = 3.32; 95 % CI: 1.72–6.42), history of diabetes mellitus (DM) (OR = 2.20; 95 % CI: 1.19–4.08), NIHSS score (OR = 3.08; 95 % CI: 2.16–4.40), anxiety (OR = 3.17; 95 % CI: 1.90–5.29) and irritability (OR = 4.61; 95 % CI: 1.36–15.63) on the 1st day of illness onset, change in NIHSS score (OR = 2.49; 95 % CI: 1.31–4.73), and circumrotating (OR = 7.80; 95 % CI: 1.98–30.64) and tinnitus (OR = 13.25; 95 % CI: 1.55–113.34) during the first 3 days of stroke onset. The total score of the scale was 16.5 and the cutoff point was 9.5, which means patients would have poor outcome at 90 days of stroke onset if the score was higher than 9.5. The new scale was validated on the data of Xuanwu hospital, and the value of its sensitivity, specificity and overall accuracy were 69.6 %, 83.3 % and 75.0 % respectively.ConclusionsThe 8-item scale, mainly based on TCM symptoms, NIHSS score and their changes during the first 3 days, can predict the 90-day outcome for IS patients while it still needs to be further validated and optimized clinically.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-015-0903-1) contains supplementary material, which is available to authorized users.

Stroke in Traditional Korean Medicine: A Nine-Year Multicentre Community-Based Study in South Korea

“…The YD pattern was associated with paleness, a red zygomatic site and dry mouth. These results were similar to other studies presented by our team and other TCM researchers 13 14 .…”

The Prognostic Value of Traditional Chinese Medicine Symptoms in Acute Ischemic Stroke: A Pilot Study

“…For instance, gurgling with sputum, which is a reflection of phlegm syndrome, might be a factor affecting the recovery of motor dysfunction. A previous study [7] used the Pearson correlation test and logistic regression model to review 489 patients with acute ischemic stroke and finally screened eight items of the scale, indicating that early appearance of anxiety might predict a bad outcome at the ninetieth (90 th ) day (OR: 3.17). Our study observed the recovery of motor function at the first year, which was much longer.…”

“…However, the current evidence showed the performance evaluation of TCM scales is uneven [6]. Scales in general accepted standards have not been applied as early predictive indicators of stroke outcome in the prognostic scale [7]. Typically, some early prognostic symptoms are important for the development of precision medicine, quality of life, and prognosis of stroke, which need to be testified in the progress of medical practice.…”

Neural Network Modeling and Correlation Analysis of Brain Plasticity Mechanisms in Stroke Patients

“…exceeded the forecasts of experienced doctors [33]. Changes in the health status assessment of health status in the framework of traditional Chinese medicine during the first 5 days after a stroke predicted a 90-day course of the disease [34]. As motor functions and movement are generally at the heart of the rehabilitation process, several studies have focused on predicting the recovery of these functions and special models have been created for this application [35].…”