title: A new prognostic scale for the early prediction of ischemic stroke recovery mainly based on traditional Chinese medicine symptoms and NIHSS score: a retrospective cohort study.
abstract: BACKGROUND
  Ischemic stroke (IS) is a common disease, often resulting in death or disability. Previous studies on prognosis of stroke mainly focused on the baseline condition or modern expensive tests. However, the change of clinical symptoms during acute stage is considerably neglected. In our study, we aim to develop a new prognostic scale to predict the 90-day outcome of IS patients.
  
  
  METHODS
  In this retrospective cohort study, a secondary data analysis was performed on 489 patients extracted from 1046 patients of 4 hospitals. A new prognostic scale was constructed to predict the recovery of IS mainly based on the National Institutes of Health Stroke Scale (NIHSS) score, traditional Chinese Medicine (TCM) symptoms & signs and the changes during the first 3 days of patients in the 3 TCM hospitals. Receiver Operating Characteristic (ROC) curve was used to determine the cutoff point for prediction. In the end, the scale was used to test the outcome of IS patients in Xuanwu hospital.
  
  
  RESULTS
  The new prognostic scale was composed of 8 items including age degree (OR = 3.32; 95 % CI: 1.72-6.42), history of diabetes mellitus (DM) (OR = 2.20; 95 % CI: 1.19-4.08), NIHSS score (OR = 3.08; 95 % CI: 2.16-4.40), anxiety (OR = 3.17; 95 % CI: 1.90-5.29) and irritability (OR = 4.61; 95 % CI: 1.36-15.63) on the 1st day of illness onset, change in NIHSS score (OR = 2.49; 95 % CI: 1.31-4.73), and circumrotating (OR = 7.80; 95 % CI: 1.98-30.64) and tinnitus (OR = 13.25; 95 % CI: 1.55-113.34) during the first 3 days of stroke onset. The total score of the scale was 16.5 and the cutoff point was 9.5, which means patients would have poor outcome at 90 days of stroke onset if the score was higher than 9.5. The new scale was validated on the data of Xuanwu hospital, and the value of its sensitivity, specificity and overall accuracy were 69.6 %, 83.3 % and 75.0 % respectively.
  
  
  CONCLUSIONS
  The 8-item scale, mainly based on TCM symptoms, NIHSS score and their changes during the first 3 days, can predict the 90-day outcome for IS patients while it still needs to be further validated and optimized clinically.
authors.affiliation: Department of Neurology, Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine, Beijing, China. kgdoctor@sina.com.
authors.forename: Ke-Gang
authors.initials: KG
authors.lastname: Cao
authors.affiliation: Department of Neurology, Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine, Beijing, China. caihong-fu@163.com.
authors.forename: Cai-Hong
authors.initials: CH
authors.lastname: Fu
authors.affiliation: Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China. hqin_li@163.com.
authors.forename: Huan-Qin
authors.initials: HQ
authors.lastname: Li
authors.affiliation: Traditional Chinese Medicine Department, Peking University Third Hospital, Beijing, China. xinxiyan198234@163.com.
authors.forename: Xi-Yan
authors.initials: XY
authors.lastname: Xin
authors.affiliation: Department of Neurology, Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine, Beijing, China. gaoying973@126.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Gao
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000534:rehabilitation; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008516:Medicine, Chinese Traditional; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis*; D000071939:Stroke Rehabilitation; D014481:United States