ArticleCerebrovascular diseases (Basel, Switzerland)2008
Baseline NIH stroke scale responses estimate the probability of each particular stroke subtype.
Article in Cerebrovascular diseases (Basel, Switzerland), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Association of Black Race With Early Recurrence After Minor Ischemic Stroke or Transient Ischemic Attack: Secondary Analysis of the POINT Randomized Clinical Trial.JAMA neurology · 2020Trial
- Real world challenges and barriers for positive airway therapy use in acute ischemic stroke patients.Sleep & breathing = Schlaf & Atmung · 2024Article
- Development and validation of a nomogram model for predicting unfavorable functional outcomes in ischemic stroke patients after acute phase.Frontiers in aging neuroscience · 2023Article
- Machine learning is an effective method to predict the 90-day prognosis of patients with transient ischemic attack and minor stroke.BMC medical research methodology · 2022Article
- Association of Socioeconomic Status and Infarct Volume With Functional Outcome in Patients With Ischemic Stroke.JAMA network open · 2022Article
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Authors and funding
4 authors.
Funding
Abstract
backgroundEmergency treatment of ischemic stroke should ideally be mechanism specific, but acute subtype diagnosis is problematic. Since different subtypes often are associated with specific patterns of neurological deficits, we hypothesize that scores on baseline NIH stroke scale (NIHSS) items may help emergently stratify patients by their probability of having a particular stroke subtype.
methodsWe performed multivariate polytomous logistic regression analyses on 1,281 patients enrolled in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST). We tested the predictive value of individual items to the baseline NIHSS exam, and syndromic combinations of those items, in anticipating the TOAST stroke subtype at 3 months adjusting for atrial fibrillation. We then used the most significant NIHSS items to construct a predictive model.
resultsThe NIHSS items that discriminate between stroke subtypes are language, neglect, visual field and brachial predominance of weakness. Among patients without atrial fibrillation, a normal score for these 4 variables conveys a 46% chance of lacunar stroke, 12% of atherothrombotic stroke and 10% of cardioembolism. This pattern gradually reverses with increased numbers of abnormal responses. Those with abnormalities in all 4 items have a 0.1% chance of lacunar stroke, 50% of atherothrombotic stroke and 39% of cardioembolism.
conclusionsLanguage, neglect, visual fields and brachial predominance of weakness in the baseline NIHSS help discriminate between subtypes, particularly between lacunar and nonlacunar strokes. Clinical trials testing interventions aimed to particular stroke mechanisms may use these NIHSS items to emergently stratify patients based on their probability of having a particular stroke subtype.
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