Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST).
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Adams
H P
HP
Department of Neurology, University of Iowa College of Medicine, Iowa City 52242, USA. harold-adams@uiowa.edu
Davis
P H
PH
Leira
E C
EC
Chang
K C
KC
Bendixen
B H
BH
Clarke
W R
WR
Woolson
R F
RF
Hansen
M D
MD
D000925:Anticoagulants / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000145:classification* / Q000188:drug therapy* / Q000503:physiopathology; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003871:Dermatan Sulfate / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006497:Heparan Sulfate / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009316:National Institutes of Health (U.S.); D011336:Probability; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D006497:Heparan Sulfate; C035838:danaparoid