title: Predictive value of the National Institutes of Health Stroke Scale and the Mini-Mental State Examination for neurologic outcome after coronary artery bypass graft surgery.
abstract: OBJECTIVE
  We intended to define the role of the National Institutes of Health Stroke Scale and the Mini-Mental State Examination in identifying adverse neurologic outcomes in a large international sample of patients undergoing cardiac surgery.
  
  
  METHODS
  We evaluated 4707 patients undergoing cardiac surgery with cardiopulmonary bypass at 72 centers in 17 countries between November 1996 and June 2000. Prespecified overt neurologic outcomes were categorized as type I (clinically diagnosed stroke, transient ischemic attack, encephalopathy, or coma) or type II (deterioration of intellectual function). The National Institutes of Health Stroke Scale and Mini-Mental State Examination were administered preoperatively and on postoperative day 3, 4, or 5. Receiver operating characteristic curves were plotted to determine the predictive value of worsening in National Institutes of Health Stroke Scale and Mini-Mental State Examination scores with respect to type I and II outcomes.
  
  
  RESULTS
  The receiver operating characteristic area under the curve for changes in National Institutes of Health Stroke Scale score (n = 4620) was 0.89 for type I outcomes and 0.66 for type II outcomes. A 1-point worsening in National Institutes of Health Stroke Scale score provided excellent discrimination (86% specificity; 84% sensitivity) of type I outcomes. The receiver operating characteristic area under the curve for changes in Mini-Mental State Examination score (n = 4707) was 0.75 for type I outcomes and 0.71 for type II outcomes. A 2-point worsening in Mini-Mental State Examination score provided only fair discrimination (73% specificity; 62% sensitivity) of type II outcomes.
  
  
  CONCLUSIONS
  We used baseline controls and postoperative worsening in National Institutes of Health Stroke Scale and Mini-Mental State Examination scores to predict both serious adverse neurologic outcome and deterioration of intellectual function. Our findings provide the only reference for evaluating these tests that are used in cardiac surgical clinical trials.
authors.affiliation: Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, NY, USA. nussmein@upstate.edu
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Nussmeier
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Miao
authors.forename: Gary W
authors.initials: GW
authors.lastname: Roach
authors.forename: Richard L
authors.initials: RL
authors.lastname: Wolman
authors.forename: Christina
authors.initials: C
authors.lastname: Mora-Mangano
authors.forename: Mark
authors.initials: M
authors.lastname: Fox
authors.forename: Andrea
authors.initials: A
authors.lastname: Szekely
authors.forename: Concezione
authors.initials: C
authors.lastname: Tommasino
authors.forename: Nanette M
authors.initials: NM
authors.lastname: Schwann
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Mangano
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D009422:Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D014481:United States