title: Neurologic Examination at 24 to 48 Hours Predicts Functional Outcomes in Basilar Artery Occlusion Stroke.
abstract: Accurate long-term outcome prognostication in basilar artery occlusion strokes may guide clinical management in the subacute stage. We determine the prognostic value of the follow-up neurological examination using the National Institutes of Health stroke scale (NIHSS) and identify 24- to 48-hour NIHSS risk categories in basilar artery occlusion patients.
  
  
  
  Participants of an observational registry of radiologically confirmed acute basilar artery occlusion (BASICS [Basilar Artery International Cooperation Study]) with prospectively collected 24- to 48-hour NIHSS and 1-month modified Rankin scale scores were included. Uni- and multivariable modeling were performed to identify independent predictors of poor outcome. Predictive powers of baseline and 24- to 48-hour NIHSS for poor outcome (modified Rankin scale, 4-6) and 1-month mortality were determined by receiver operating characteristic analyses. Classification and regression tree analysis was performed to identify risk groups.
  
  
  
  Three hundred seventy-six of 619 BASICS participants were included, of whom 65.4% had poor outcome. In multivariable analyses, 24- to 48-hour NIHSS (odds ratio=1.28 [1.21-1.35]), history of minor stroke (odds ratio=2.64 [1.04-6.74], time to treatment >6 hours (odds ratio=3.07 [1.35-6.99]), and age (odds ratio=1.02 [0.99-1.04]) were retained in the final model as predictors of poor outcome. Prognostic power of 24- to 48-hour NIHSS was higher than baseline NIHSS for 1-month poor outcome (area under the curve, 0.92 versus 0.75) and mortality (area under the curve, 0.85 versus 0.72). Classification and regression tree analysis identified five 24- to 48-hour NIHSS risk categories with poor outcome rates of 9.4% (NIHSS 0-4), 36% (NIHSS 5-11), 84.3% (NIHSS 12-22), 96.1% (NIHSS 23-27), and 100% (NIHSS≥28).
  
  
  
  Twenty-four- to 48-hour NIHSS accurately predicts 1-month poor outcome and mortality and represents a clinically valuable prognostic tool for the care of basilar artery occlusion patients.
authors: From the Department of Neurology, Emory University Hospital (S.R., M.F., R.G.N.) and Grady Memorial Hospital (S.R., M.F., R.G.N.), Atlanta, GA; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (W.J.S., A.A., L.J.K.); Department of Neurology, St Antonius Hospital, Nieuwegein, The Netherlands (W.J.S.); and Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.). srangar@emory.edu.
authors: Srikant
authors: S
authors: Rangaraju
authors: From the Department of Neurology, Emory University Hospital (S.R., M.F., R.G.N.) and Grady Memorial Hospital (S.R., M.F., R.G.N.), Atlanta, GA; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (W.J.S., A.A., L.J.K.); Department of Neurology, St Antonius Hospital, Nieuwegein, The Netherlands (W.J.S.); and Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.).
authors: Tudor G
authors: TG
authors: Jovin
authors: From the Department of Neurology, Emory University Hospital (S.R., M.F., R.G.N.) and Grady Memorial Hospital (S.R., M.F., R.G.N.), Atlanta, GA; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (W.J.S., A.A., L.J.K.); Department of Neurology, St Antonius Hospital, Nieuwegein, The Netherlands (W.J.S.); and Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.).
authors: Michael
authors: M
authors: Frankel
authors: From the Department of Neurology, Emory University Hospital (S.R., M.F., R.G.N.) and Grady Memorial Hospital (S.R., M.F., R.G.N.), Atlanta, GA; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (W.J.S., A.A., L.J.K.); Department of Neurology, St Antonius Hospital, Nieuwegein, The Netherlands (W.J.S.); and Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.).
authors: Wouter J
authors: WJ
authors: Schonewille
authors: From the Department of Neurology, Emory University Hospital (S.R., M.F., R.G.N.) and Grady Memorial Hospital (S.R., M.F., R.G.N.), Atlanta, GA; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (W.J.S., A.A., L.J.K.); Department of Neurology, St Antonius Hospital, Nieuwegein, The Netherlands (W.J.S.); and Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.).
authors: Ale
authors: A
authors: Algra
authors: From the Department of Neurology, Emory University Hospital (S.R., M.F., R.G.N.) and Grady Memorial Hospital (S.R., M.F., R.G.N.), Atlanta, GA; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (W.J.S., A.A., L.J.K.); Department of Neurology, St Antonius Hospital, Nieuwegein, The Netherlands (W.J.S.); and Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.).
authors: L Jaap
authors: LJ
authors: Kappelle
authors: From the Department of Neurology, Emory University Hospital (S.R., M.F., R.G.N.) and Grady Memorial Hospital (S.R., M.F., R.G.N.), Atlanta, GA; Department of Neurology, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (W.J.S., A.A., L.J.K.); Department of Neurology, St Antonius Hospital, Nieuwegein, The Netherlands (W.J.S.); and Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.).
authors: Raul G
authors: RG
authors: Nogueira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging
keywords: brain ischemia; critical care outcomes; decision support techniques; neurologic examination; prognosis; stroke; vertebrobasilar insufficiency