Baseline NIH Stroke Scale is an inferior predictor of functional outcome in the era of acute stroke intervention

Abstract

Background and aims Baseline National Institutes of Health Stroke Scale (NIHSS) scores have frequently been used for prognostication after ischemic stroke. With the increasing utilization of acute stroke interventions, we aimed to determine whether baseline NIHSS scores are still able to reliably predict post-stroke functional outcome. Methods We retrospectively analyzed prospectively collected data from a high-volume tertiary-care center. We tested strength of association between NIHSS scores at baseline and 24 h with discharge NIHSS using Spearman correlation, and diagnostic accuracy of NIHSS scores in predicting favorable outcome at three months (defined as modified Rankin Scale 0-2) using receiver operating characteristic curve analysis with area under the curve. Results There were 1183 patients in our cohort, with median baseline NIHSS 8 (IQR 3-17), 24-h NIHSS 4 (IQR 1-11), and discharge NIHSS 2 (IQR 1-8). Correlation with discharge NIHSS was r = 0.60 for baseline NIHSS and r = 0.88 for 24-h NIHSS. Of all patients with follow-up data, 425/1037 (41%) had favorable functional outcome at three months. Receiver operating characteristic curve analysis for predicting favorable outcome showed area under the curve 0.698 (95% CI 0.664-0.732) for baseline NIHSS, 0.800 (95% CI 0.772-0.827) for 24-h NIHSS, and 0.819 (95% CI 0.793-0.845) for discharge NIHSS; 24 h and discharge NIHSS maintained robust predictive accuracy for patients receiving mechanical thrombectomy (AUC 0.846, 95% CI 0.798-0.895; AUC 0.873, 95% CI 0.832-0.914, respectively), while accuracy for baseline NIHSS decreased (AUC 0.635, 95% CI 0.566-0.704). Conclusion Baseline NIHSS scores are inferior to 24 h and discharge scores in predicting post-stroke functional outcomes, especially in patients receiving mechanical thrombectomy.

Prediction of the functional outcome of acute recurrent cerebral ischemic hemispheric stroke

“…It coincides with S. A. Raza et al (2017) study where it was proved that total NIHSS score >10 is a predictor of severe disability [19]. However, in studies by M. E. Reznik et al (2018) [20] and V. Inoa et al (2014) [7] in which first-time CHIS patients were involved, the NIHSS total score for determining the risk of UFO was slightly lower: ≥6 and ≥8 respectively.…”

Fall assessment in subacute inpatient stroke rehabilitation using clinical characteristics and the most preferred stroke severity and outcome measures

“…The association we found between admission NIHSS score (moderate to severe) and incidents shows a similar nonlinear pattern of relationship: the fallers did not have extreme scores in NIHSS, either. Even if the 24 h NIHSS is used to predict functional outcome in acute stroke [79], it was not capable of predicting future falls in this subacute stroke rehabilitant population. Irrespective of the baseline situation, as time passes the change in neurological and functional status and the different predicting tools applied make straight comparisons of falls in acute, subacute and chronic stroke unreasonable [14].…”

Predictors of discharge outcomes following percutaneous mechanical thrombectomy in patients with acute ischemic stroke: Comparisons between the home discharge group and hospital transfer group

“…According to Wirtz et al 21 , NIHSS score at 24 hours postoperatively correlates with functional outcome at 90 days postoperatively. Some have reported that outcomes were good when NIHSS score at 24 hours after surgery was 5 points or less [22][23][24] . We set NIHSS score at 24 hours after surgery for 5 points as a cutoff in this study.…”