ArticleJournal of general internal medicine2022
Medicare Claim-Based National Institutes of Health Stroke Scale to Predict 30-Day Mortality and Hospital Readmission.
Article in Journal of general internal medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- Factors associated with post-stroke readmission: a systematic review and meta analysis.Scientific reports · 2025Pooled it
- Prediction Models for Post-Stroke Hospital Readmission: A Systematic Review.Public health nursing (Boston, Mass.)Pooled it
- Gabapentin and cognitive impairment after traumatic brain injury: A multinational cohort of 49,925 patients.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2026Article
- Predicting 30-Day Readmission After Stroke: A Systematic Review and Meta-Analysis to Inform Predictor Selection.Diagnostics (Basel, Switzerland) · 2026Review
- Trends and disparities in NIHSS reporting and outcomes in acute ischemic stroke hospitalizations: A retrospective cross-sectional study.Acta neurochirurgica · 2026Article
- Association of Dual Eligibility and Medicare Type With Quality of Postacute Care After Stroke.JAMA network open · 2026Article
- Neighborhood economic and demographic landscape as predictors of 90-day outcomes post-stroke hospitalization.Frontiers in stroke · 2026Article
- Article
- A prediction for sepsis in adult patients with severe cerebrovascular disease from neurological intensive care unit.Frontiers in neurology · 2025Article
- Construction of a machine learning-based prediction model for unfavorable discharge outcomes in patients with ischemic stroke.Heliyon · 2024Article
- The effect of post-acute rehabilitation setting on 90-day mobility after stroke: A difference-in-difference analysis.medRxiv : the preprint server for health sciences · 2024Article
- Association of Caregiver Availability and Training With Patient Community Discharge After Stroke.Archives of rehabilitation research and clinical translation · 2023Article
- Validation of theCirculation. Cardiovascular quality and outcomes · 2023Article
- Association of Medicare-Medicaid Dual Eligibility and Race and Ethnicity With Ischemic Stroke Severity.JAMA network open · 2022Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe Centers for Medicare and Medicaid Services (CMS) penalizes hospitals for higher than expected 30-day mortality rates using methods without accounting for condition severity risk adjustment. For patients with stroke, CMS claims did not quantify stroke severity until recently, when the National Institutes of Health Stroke Scale (NIHSS) reporting began.
objectiveExamine the predictive ability of claim-based NIHSS to predict 30-day mortality and 30-day hospital readmission in patients with ischemic stroke.
designRetrospective cohort study of Medicare claims data. PATIENTS: Medicare beneficiaries with ischemic stroke (N=43,241) acute hospitalization between October 2016 and November 2017. MEASUREMENTS: All-cause 30-day mortality and 30-day hospital readmission. NIHSS score was derived from ICD-10 codes and stratified into the following: minor to moderate, moderate, moderate to severe, and severe categories.
resultsAmong 43,241 patients with ischemic stroke with NIHSS from 2,659 US hospitals, 64.6% had minor to moderate stroke, 14.3% had moderate, 12.7% had moderate to severe, and 8.5% had a severe stroke,10.1% died within 30 days, 12.1% were readmitted within 30 days. The NIHSS exhibited stronger discriminant property (C-statistic 0.83, 95% CI: 0.82-0.84) for 30-day mortality compared to Elixhauser (0.74, 95% CI: 0.73-0.75). A monotonic increase in the adjusted 30-day mortality risk occurred relative to minor to moderate stroke category: hazard ratio [HR]=2.92 (95% CI=2.59-3.29) for moderate stroke, HR=5.49 (95% CI=4.90-6.15) for moderate to severe stroke, and HR=7.82 (95% CI=6.95-8.80) for severe stroke. After accounting for competing risk of mortality, there was a significantly higher readmission risk in the moderate stroke (HR=1.11, 95% CI=1.03-1.20), but significantly lower readmission risk in the severe stroke (HR=0.84, 95% CI=0.74-0.95) categories. LIMITATION: Timing of NIHSS reporting during hospitalization is unknown.
conclusionsMedicare claim-based NIHSS is significantly associated with 30-day mortality in Medicare patients with ischemic stroke and significantly improves discriminant property relative to the Elixhauser comorbidity index.
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