Evidence map›Paper›PMID 39404848›Full record

ArticleClinical neuroradiology2025

Factors Influencing the Association of 24-hour National Institutes of Health Stroke Scale & 90-day Modified Rankin Score.

Alexander Stebner, Salome L Bosshart, Andrew Demchuk, Alexandre Poppe, Raul Nogueira, Ryan McTaggart, Brian Buck, Aravind Ganesh, Michael Hill, Mayank Goyal and 1 more

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Article in Clinical neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Alexander StebnerDepartment of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.
Salome L BosshartDepartment of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.
Andrew DemchukDepartment of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.
Alexandre PoppeCentre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Raul NogueiraUniversity of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Ryan McTaggartWarren Alpert School of Medicine, Brown University, Providence, RI, USA.
Brian BuckUniversity of Alberta Hospital, Edmonton, AB, Canada.
Aravind GaneshDepartment of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.
Michael HillDepartment of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.
Mayank GoyalDepartment of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.
Johanna OspelDepartment of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada. johannaospel@gmail.com.ORCID http://orcid.org/0000-0003-0029-6764

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe modified Rankin Scale (mRS) at 90 days is the primary outcome in most acute stroke studies, but the long follow-up period has disadvantages. The National Institutes of Health Stroke Scale (NIHSS) at 24 h shows a strong, but imperfect, association with 90-day mRS. This study examines the association between 24-hour NIHSS and 90-day mRS and reasons for discrepancies.

methodsData are from the ESCAPE-NA1 thrombectomy patients. To address the non-normality distribution of the NIHSS and include deceased patients, a 7-point ordinal score was generated by grouping 24-hour NIHSS. The association of ordinal 24-hour NIHSS and 90-day mRS was assessed with adjusted ordinal logistic regression. Differences in baseline and treatment/post-treatment variables were compared between patients with discordant and concordant outcomes.

resultsOne-thousand-seventy-six patients with available 24-hour NIHSS and 90-day mRS were included (median 24-hour NIHSS 6[IQR: 2-14], median 90-day mRS 2[IQR: 1-4]). Ordinal 24-hour NIHSS was associated with 90-day mRS (adjusted cOR 2.53 [95%CI 2.33-2.74]). Forty-eight (4.5%) patients had discordant outcomes. Of those, 19(1.8%) had 24-hour NIHSS < 6 and 90-day mRS5-6; all of which had ≥ 1 severe adverse event, most commonly pneumonia (6[31.6%]) or recurrent stroke (4[21.1%]). Twenty-nine patients (2.7%) had 24-hour NIHSS > 14 and 90-day mRS 0-2. In these patients, baseline NIHSS and ASPECTS was lower, and collateral status was worse.

conclusionAn ordinal NIHSS score that includes death at 24 h shows a strong association with 90-day mRS, suggesting that it could be used as an alternative outcome. Patients with discrepant outcomes differed from the remaining patients regarding their baseline NIHSS, ASPECTS, collateral status, and post-stroke complications.

Indexed as

Severity of Illness IndexStrokeAgedAged, 80 and overFemaleHumansMaleMiddle AgedNational Institutes of Health (U.S.)ThrombectomyTime FactorsTreatment OutcomeUnited StatesAcute ischemic strokeCerebrovascular diseaseClinical outcomesModified Rankin ScaleNational Institutes of Health Stroke Scale

Identifiers

PMID39404848

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.