National Institutes of Health Stroke Scale Item Profiles as Predictor of Patient Outcome

Abdul-Rahim, Azmil H; Fulton, Rachael L.; Sucharew, Heidi; Kleindorfer, Dawn; Khatri, Pooja; Broderick, Joseph P.; Lees, Kennedy R.; Alexandrov, Andrei V.; Bath, Philip M.W.; Bluhmki, Erich; Bornstein, Natan M.; Claesson, Lennart; Curram, John; Davis, Stephen; Donnan, Geoffrey A.; Diener, H. C.; Fisher, Miles; Ginsberg, Myron D.; Gregson, Barbara; Grotta, James C.; Hacke, Werner; Hennerici, Michael G.; Hommel, Marc; Kaste, Markku; Lyden, Patrick; Marler, John R.; Muir, Keith W.; Sacco, R.; Shuaib, Ashfaq; Teal, Philip; Wahlgren, Nils; Warach, Steven; Weimar, Christian

doi:10.1161/strokeaha.114.006837

Cited by 31 publications

(11 citation statements)

References 21 publications

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“…The importance of functional impairment (pre and post stroke disability) in defining clusters and initial stroke severity is consistent with previous studies [23,24]. However, there is no consensus on when measuring functional status, with a recent study describing a good correlation between its assessment during the first five days and the independence for activities of daily living at six months [31].…”

Section: Discussionsupporting

confidence: 83%

Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study

et al. 2016

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BackgroundStroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units.MethodsWe performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis. We also proposed a practical decision tree for patient’s classification in clinical practice. We analyzed differences between profiles in functional improvement (Barthel index), relative functional gain (Montebello index), length of hospital stay (LOS), rehabilitation efficiency (functional improvement by LOS), and new institutionalization using multivariable regression models (for continuous and dichotomous outcomes).ResultsAmong 384 patients (79.1±7.9 years, 50.8% women), we identified 3 complexity profiles: a) Lower Complexity with Caregiver (LCC), b) Moderate Complexity without Caregiver (MCN), and c) Higher Complexity with Caregiver (HCC). The decision tree showed high agreement with cluster analysis (96.6%). Using either linear (continuous outcomes) or logistic regression, both LCC and MCN, compared to HCC, showed statistically significant higher chances of functional improvement (OR = 4.68, 95%CI = 2.54–8.63 and OR = 3.0, 95%CI = 1.52–5.87, respectively, for Barthel index improvement ≥20), relative functional gain (OR = 4.41, 95%CI = 1.81–10.75 and OR = 3.45, 95%CI = 1.31–9.04, respectively, for top Vs lower tertiles), and rehabilitation efficiency (OR = 7.88, 95%CI = 3.65–17.03 and OR = 3.87, 95%CI = 1.69–8.89, respectively, for top Vs lower tertiles). In relation to LOS, MCN cluster had lower chance of shorter LOS than LCC (OR = 0.41, 95%CI = 0.23–0.75) and HCC (OR = 0.37, 95%CI = 0.19–0.73), for LOS lower Vs higher tertiles.ConclusionOur data suggest that post-stroke rehabilitation profiles could be identified using routine assessment tools and showed differential recovery. If confirmed, these findings might help to develop tailored interventions to optimize recovery of older stroke patients.

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Section: Discussionsupporting

confidence: 83%

Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study

et al. 2016

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“…Stroke has recently overtaken cancer as the most common cause of death in China [ 1 ] and can seriously affect patients’ quality of life and place a great burden upon both patients’ families and society. Ischemic stroke constitutes 87% of all strokes, [ 2 ] and there is an urgent unmet need to identify risk factors associated with ischemic stroke for use in reducing the incidence, recurrence, morbidity, and mortality of this condition.…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of prognosis and risk factors of patients with stroke by TOAST

Wei¹,

Su-ting

San³

et al. 2018

Medicine

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To determine differences in 90-day mortality and identify risk factors among different etiological classifications of ischemic stroke using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification.Our retrospective analysis included 538 ischemic stroke patients. The cause of stroke was categorized according to the TOAST criteria, and 90-day mortality rates were obtained through the patient follow-up. Age, sex, previous medical history, and clinical features were used in the analysis of potential risk factors.There were 38 deaths during the 90-day follow-up period. Patients in the undetermined cause subgroups experienced significantly higher mortality rate than those in subgroups with small artery occlusion and large artery atherosclerosis. Factors independently associated with 90-day mortality for patients with the large artery atherosclerosis stroke subtype were age (95% confidence interval [CI], 1.010–1.192, P = .028), history of hypertension (95% CI, 3.030–99.136, P = .001), high blood glucose (95% CI, 1.273–2.354, P < .001), high cholesterol (95% CI, 0.017–0.462, P = .004), high uric acid (95% CI, 2.360–64.389, P = .003), and National Institute of Health Stroke Scale(95% CI, 1.076–1.312, P = .001). Age (95% CI, 1.012–1.358, P = .034) and high cholesterol (95% CI, 0.011–0.496, P = .007) were independently associated with 90-day mortality for patients with the small artery occlusion subtype of stroke.Our analysis identified that certain risk factors and 90-day mortality differ significantly among different stroke subtypes, as classified by the TOAST criteria. These risk factors must be considered carefully to provide the best clinical management of these patients and thus reduce mortality.

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“…In this study, NIHSS score was used to evaluate the severity of cerebral infarction, and there were two patients with moderate degree stroke and nine patients with severe degree stroke. NIHSS score is an independent predictor of post-stroke outcome, which is helpful to assess the prognosis of patients with acute stroke (13). The patients with NIHSS score >14 score have higher mortality rate and poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of Clinical Characteristics of Rare Bilateral Cerebral Peduncular Infarction

Chen

Raza

et al. 2019

Front. Neurol.

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Objective: To investigate the anatomical characteristics, clinical manifestations, and imaging features of bilateral cerebral peduncular infarction.Methods: A retrospective analysis was performed on 11 patients diagnosed with bilateral cerebral peduncular infarction in the Affiliated Hospital of Xuzhou Medical University from December 2014 to December 2018. Their clinical and imaging features were analyzed and summarized in combination with the relevant national and international literature.Results: Among all the patients, there were eight cases with a history of hypertension, four cases with a history of diabetes mellitus, and four cases with a history of smoking. Conscious disturbance was observed in nine cases, quadriplegia in seven cases, pseudobulbar paralysis in three cases, and ataxia in one case. Brain magnetic resonance (MR) scans of bilateral cerebral peduncles showed patchy abnormal shadows with a hypointense signal on T1-weighted imaging (T1WI) and apparent diffusion coefficient (ADC) and hyperintense signal on T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI). Computed tomography angiography (CTA) scans of head and neck showed severe stenosis or occlusion of vertebral artery, basilar artery, or posterior cerebral artery. All the patients received standardized treatment for cerebral infarction. Six patients died while five were left disabled.Conclusion: Bilateral cerebral peduncle infarction may be related to cerebral perfusion insufficiency caused by the stenosis or occlusion of vertebrobasilar artery and its branches. The main clinical manifestations are locked-in syndrome and persistent vegetative state. The specific imaging feature of “Mickey Mouse ear”-like infarction is associated with a poor prognosis.

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National Institutes of Health Stroke Scale Item Profiles as Predictor of Patient Outcome

Cited by 31 publications

References 21 publications

Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study

Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study

Retrospective analysis of prognosis and risk factors of patients with stroke by TOAST

An Analysis of Clinical Characteristics of Rare Bilateral Cerebral Peduncular Infarction

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