Utility of Items of Baseline National Institutes of Health Stroke Scale as Predictors of Functional Outcomes at Three Months after Mild Ischemic Stroke.
BACKGROUND
Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits is crucial in decision making regarding thrombolytic therapy. We examined the utility of individual National Institutes of Health Stroke Scale (NIHSS) score items or clusters of items as predictors of functional outcomes at 3 months after mild stroke.


METHODS
Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had baseline NIHSS scores less than or equal to 5. Functional outcomes at 3 months were dichotomized as favorable (modified RankinScale [mRS] score 0 or 1) or unfavorable (mRS 2-6). Individual NIHSS items, clusters of items, and the total score were tested for their ability to predict outcomes in multivariable models. Area under the receiver operating characteristic curve (AUC) was used to assess model performance.


RESULTS
Of the 2209 patients who met eligibility criteria, 588 (26.6%) exhibited unfavorable functional outcomes at 3 months. Of the 15 items of the NIHSS, all except item 8 (sensory) and item 11 (extinction) were significantly associated with unfavorable functional outcomes in bivariate analysis (P's < .05). Among the multivariable models, the model with the total NIHSS score exhibited an AUC similar to that of the model with all NIHSS items in predicting functional outcomes (.758 [95% confidence interval .739-.775] versus .759 [.740-.776]; P = .75 for pairwise comparison).


CONCLUSIONS
Simply using the total NIHSS score was as effective as using all individual items in predicting outcomes of mild stroke patients.
Department of Neurology, Jeju National University Hospital, Jeju, Republic of Korea.
Jay Chol
JC
Choi
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Beom Joon
BJ
Kim
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Moon-Ku
MK
Han
Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea.
Soo Joo
SJ
Lee
Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Republic of Korea.
Kyusik
K
Kang
Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Republic of Korea.
Jong-Moo
JM
Park
Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea.
Sang-Soon
SS
Park
Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea.
Tai Hwan
TH
Park
Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea.
Yong-Jin
YJ
Cho
Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea.
Keun-Sik
KS
Hong
Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
Kyung Bok
KB
Lee
Department of Neurology, Yeungnam University Hospital, Daegu, Republic of Korea.
Jun
J
Lee
Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
Wi-Sun
WS
Ryu
Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
Dong-Eog
DE
Kim
Department of Neurology, Dong-A University College of Medicine, Busan, Republic of Korea.
Hyun-Wook
HW
Nah
Department of Neurology, Dong-A University College of Medicine, Busan, Republic of Korea.
Dae-Hyun
DH
Kim
Department of Neurology, Dong-A University College of Medicine, Busan, Republic of Korea.
Jae-Kwan
JK
Cha
Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea.
Joon-Tae
JT
Kim
Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea.
Kang-Ho
KH
Choi
Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
Mi Sun
MS
Oh
Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
Kyung-Ho
KH
Yu
Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
Byung-Chul
BC
Lee
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Myung Suk
MS
Jang
Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea.
Ji Sung
JS
Lee
Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
Juneyoung
J
Lee
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea. Electronic address: braindoc@snu.ac.kr.
Hee-Joon
HJ
Bae
D000368:Aged; D019540:Area Under Curve; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D020127:Recovery of Function; D012042:Registries; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D015912:Thrombolytic Therapy; D013997:Time Factors
Mild stroke; NIHSS; outcome assessment; prognosis