Baseline NIH Stroke Scale score strongly predicts outcome after stroke

TLDR

The study compared baseline NIHSS scores and TOAST stroke subtypes as predictors of 7‑day and 3‑month outcomes after ischemic stroke. Using data from 1,281 trial participants, the authors assessed outcomes at 7 days and 3 months with the Barthel Index and Glasgow Outcome Scale, defining excellent outcomes as GOS = 1 and BI ≥ 19, and adjusted analyses for age, sex, race, and prior stroke. Baseline NIHSS strongly predicted outcomes, with each additional point reducing the odds of an excellent outcome by 24% at 7 days and 17% at 3 months; at 3 months, 46% of patients with NIHSS 7‑10 and 23% with NIHSS 11‑15 achieved excellent outcomes, lacunar stroke had an OR 3.1 for excellent outcome, and scores ≥16 forecast death or severe disability while ≤6 forecast good recovery.

Abstract

To compare the baseline National Institutes of Health Stroke Scale (NIHSS) score and the Trial of Org 10172 in Acute Stroke Treatment (TOAST) stroke subtype as predictors of outcomes at 7 days and 3 months after ischemic stroke.Using data collected from 1,281 patients enrolled in a clinical trial, subtype of stroke was categorized using the TOAST classification, and neurologic impairment at baseline was quantified using the NIHSS. Outcomes were assessed at 7 days and 3 months using the Barthel Index (BI) and the Glasgow Outcome Scale (GOS). An outcome was rated as excellent if the GOS score was 1 and the BI was 19 or 20 (scale of 0 to 20). Analyses were adjusted for age, sex, race, and history of previous stroke.The baseline NIHSS score strongly predicted outcome, with one additional point on the NIHSS decreasing the likelihood of excellent outcomes at 7 days by 24% and at 3 months by 17%. At 3 months, excellent outcomes were noted in 46% of patients with NIHSS scores of 7 to 10 and in 23% of patients with scores of 11 to 15. After multivariate adjustment, lacunar stroke had an odds ratio of 3.1 (95% CI, 1.5 to 6.4) for an excellent outcome at 3 months.The NIHSS score strongly predicts the likelihood of a patient's recovery after stroke. A score of > or =16 forecasts a high probability of death or severe disability whereas a score of < or =6 forecasts a good recovery. Only the TOAST subtype of lacunar stroke predicts outcomes independent of the NIHSS score.