title: Predicting prognosis after stroke: a placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial.
abstract: BACKGROUND
  Physicians are often asked to predict outcome after acute stroke. Very little information is available that can reliably predict the likelihood of severe disability or death.
  
  
  OBJECTIVE
  To develop a practical method for predicting a poor outcome after acute ischemic stroke.
  
  
  METHODS
  Data from the placebo arms of Parts 1 and 2 of the National Institute of Neurological Disorders and Stroke rt-PA [recombinant tissue plasminogen activator] Stroke Trial were used to identify variables that could predict a poor outcome, defined as moderately severe disability, severe disability, or death (Modified Rankin Scale score >3) 3 months after stroke.
  
  
  RESULTS
  Baseline variables that predicted poor outcome were the NIH Stroke Scale (NIHSS) >17 plus atrial fibrillation, yielding a positive predictive value (PPV) of 96% (95% CI, 88 to 100%). The best predictor at 24 hours was NIHSS >22, yielding a PPV of 98% (95% CI, 93 to 100%). The best predictor at 7 to 10 days was NIHSS >16, yielding a PPV of 92% (95% CI, 85 to 99%).
  
  
  CONCLUSIONS
  Patients with a severe neurologic deficit after acute ischemic stroke, as measured by the NIHSS, have a poor prognosis. During the first week after acute ischemic stroke, it is possible to identify a subset of patients who are highly likely to have a poor outcome. These findings require confirmation in a separate study.
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA, USA. mfranke@emory.edu
authors.forename: M R
authors.initials: MR
authors.lastname: Frankel
authors.forename: L B
authors.initials: LB
authors.lastname: Morgenstern
authors.forename: T
authors.initials: T
authors.lastname: Kwiatkowski
authors.forename: M
authors.initials: M
authors.lastname: Lu
authors.forename: B C
authors.initials: BC
authors.lastname: Tilley
authors.forename: J P
authors.initials: JP
authors.lastname: Broderick
authors.forename: R
authors.initials: R
authors.lastname: Libman
authors.forename: S R
authors.initials: SR
authors.lastname: Levine
authors.forename: T
authors.initials: T
authors.lastname: Brott
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008959:Models, Neurological; D010919:Placebos; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D020521:Stroke / Q000503:physiopathology*
chemical_list: D010919:Placebos