NIHSS cut point for predicting outcome in supra- vs infratentorial acute ischemic stroke
| Autor: | Cheryl Carcel, Hardeep Aujla, CHEN-JUNE SEAK, John Chalmers, Jose Manuel Matamala, Mark Woodward, Sarah Samantha Richtering, Xia Wang, Joanna Wardlaw, Laurent Billot, Candice Delcourt, Tissa Wijeratne, Victoria Haunton |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Datasets as Topic Logistic regression Severity of Illness Index law.invention Brain Ischemia 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Fibrinolytic Agents law Modified Rankin Scale Internal medicine Severity of illness medicine Humans cardiovascular diseases 030212 general & internal medicine Stroke Aged Randomized Controlled Trials as Topic Receiver operating characteristic business.industry Thrombolysis Recovery of Function Middle Aged medicine.disease Tissue Plasminogen Activator Cardiology Female Neurology (clinical) business 030217 neurology & neurosurgery Fibrinolytic agent |
| Zdroj: | Neurology. 91(18) |
| ISSN: | 1526-632X |
| Popis: | ObjectiveTo determine the optimal cut point on the NIH Stroke Scale (NIHSS) for predicting poor 90-day clinical outcome in patients with supratentorial and infratentorial acute ischemic stroke (AIS).MethodsData are from participants of the alteplase-dose arm of the randomized controlled trial, Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Associations between baseline characteristics of clinically defined supratentorial and infratentorial AIS patients and poor functional outcome, defined by scores 3–6 on the modified Rankin Scale, were evaluated in logistic regression models, with area under the curve (AUC) receiver operating characteristics defining the optimal NIHSS predictor cut point.ResultsPatients with infratentorial AIS (n = 289) had lower baseline NIHSS scores than those with supratentorial AIS (n = 2,613) (median 7 vs 9; p < 0.001). NIHSS cut points for poor outcome were 10 (AUC 76, sensitivity 65%, specificity 73%) and 6 (AUC 69, sensitivity 72%, specificity 56%) in supratentorial and infratentorial AIS, respectively. There was no significant difference in functional outcome or symptomatic intracranial hemorrhage between AIS types.ConclusionsIn thrombolysis-eligible AIS patients, the NIHSS may underestimate clinical severity for infratentorial compared to supratentorial lesions for a similar prognosis for recovery. Because thrombolysis treatment has low effect on stroke outcome in patients with infratentorial AIS when baseline NIHSS score is more than 6, additional treatment such as endovascular treatment should be considered to improve stroke outcome.Clinicaltrials.gov identifierNCT01422616. |
| Databáze: | OpenAIRE |
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