Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2005 Oct;1(2):148-58.
doi: 10.3988/jcn.2005.1.2.148. Epub 2005 Oct 20.

Predicting the Long-Term Outcome after Subacute Stroke within the Middle Cerebral Artery Territory

Oh Young Bang  1 , Hee Young Park, Jung Han Yoon, Seung Hyeon Yeo, Ji Won Kim, Mi Ae Lee, Mi Hee Park, Phil Hyu Lee, In Soo Joo, Kyoon Huh
Affiliations

Predicting the Long-Term Outcome after Subacute Stroke within the Middle Cerebral Artery Territory

Oh Young Bang et al. J Clin Neurol. 2005 Oct.

Abstract

Background and purpose: The National Institutes of Health Stroke Scale (NIHSS) score is known to be effective in predicting the likelihood of recovery after stroke. However, the baseline NIHSS score predicts long-term outcomes rather crudely because early changes in stroke scores may influence the stroke outcomes. Therefore, a precise prognostic algorithm or a cutoff point for predicting long-term outcomes based on data from serial NIHSS scores is needed.

Methods: We serially assessed 437 patients with acute symptomatic ischemic stroke within the middle cerebral artery territory who presented with nonlacunar stroke and were followed-up for at least 6 months after symptom onset. The NIHSS score was serially checked at 0, 1, 3, 7, and 14 days after admission. In all patients, the Barthel index (BI) and the modified Rankin Scale (mRS) score were checked, with a poor outcome defined as any of the following endpoints: death, modified mRS score of >3, or BI of <60.

Results: A marked neurological improvement or worsening (i.e., a change in the NIHSS score of at least 4) was seen in 13.5% or 5.5% of the patients, respectively, during the first 7 days after admission. About 25% of the 437 patients had poor long-term outcomes. Analysis of receiver operating characteristic curves showed that the NIHSS score at day 7 after admission was better for predicting poor long-term outcomes than was the baseline score (P=0.003). In addition, we analyzed the cutoff point of the 7th-day NIHSS score for predicting a poor outcome at 6 months after symptom onset. An NIHSS score of at least 6 at day 7 after admission predicted poor long-term outcomes with a sensitivity of 84% [95% confidence interval (CI), 76-90%], a specificity of 92% (95% CI, 88-94%), and positive and negative predictive values of 77% and 95%, respectively. A logistic regression analysis revealed that age, diffusion-weighted imaging lesion volume, stroke history, and 7th-day NIHSS score were independently associated with poor outcome. However, no score used in addition to the 7th-day NIHSS score improved the prediction of a poor outcome.

Conclusions: An NIHSS score of at least 6 on day 7 after admission accurately forecasts a poor long-term outcome after stroke. Our data may be helpful in predicting the long-term prognosis as well as in making decisions regarding novel therapeutic applications in subacute-stroke trials.

Keywords: Ischemic stroke; Outcome; Stroke scale.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Patient selection.
Figure 2
Figure 2
(A) Frequency distribution of baseline NIHSS scores in the study population. (B) Infarct volume as measured by DWI for each baseline NIHSS score in the study population.
Figure 3
Figure 3
Comparisons of the ROC curve between (A) baseline and 7th-day NIHSS scores, and (B) 7th- and 14th-day NIHSS scores.
Figure 4
Figure 4
Comparisons of the ROC curve between the NIHSS criteria and the models for (A) a poor prognosis and (B) an excellent prognosis.
See this image and copyright information in PMC

References

    1. De Haan R, Horn J, Limburg M, Van Der Meulen J, Bossuyt P. A comparison of five stroke scales with measures of disability, handicap, and quality of life. Stroke. 1993;24:1178–1181. - PubMed
    1. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–1587. - PubMed
    1. Fiorelli M, Alperovitch A, Argentino C, Sacchetti ML, Toni D, Sette G, et al. Prediction of long-term outcome in the early hours following acute ischemic stroke. Italian Acute Stroke Study Group. Arch Neurol. 1995;52:250–255. - PubMed
    1. Muir KW, Weir CJ, Murray GD, Povey C, Lees KR. Comparison of neurological scales and scoring systems for acute stroke prognosis. Stroke. 1996;27:1817–1820. - PubMed
    1. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Acute stroke. Prognosis and a prediction of the effect of medical treatment on outcome and health care utilization. The Copenhagen Stroke Study. Neurology. 1997;49:1335–1342. - PubMed