| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Division of Cerebrovascular Diseases, Department of Neurology (Drs. Adams, Davis, Leira, Chang, and Bendixen), and the Division of Biostatistics, Department of Preventive Medicine (Drs. Clarke and Woolson, and M.D. Hansen), University of Iowa College of Medicine, Iowa City, IA.
Address correspondence and reprint requests to Dr. Harold P. Adams, Department of Neurology, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242; e-mail: harold-adams{at}uiowa.edu
OBJECTIVE: To compare the baseline National Institutes of Health Stroke Scale (NIHSS) score and the Trial of Org 10172 in Acute Stroke Treatment (TOAST) stroke subtype as predictors of outcomes at 7 days and 3 months after ischemic stroke.
METHODS: Using data collected from 1,281 patients enrolled in a clinical trial, subtype of stroke was categorized using the TOAST classification, and neurologic impairment at baseline was quantified using the NIHSS. Outcomes were assessed at 7 days and 3 months using the Barthel Index (BI) and the Glasgow Outcome Scale (GOS). An outcome was rated as excellent if the GOS score was 1 and the BI was 19 or 20 (scale of 0 to 20). Analyses were adjusted for age, sex, race, and history of previous stroke.
RESULTS: The baseline NIHSS score strongly predicted outcome, with one additional point on the NIHSS decreasing the likelihood of excellent outcomes at 7 days by 24% and at 3 months by 17%. At 3 months, excellent outcomes were noted in 46% of patients with NIHSS scores of 7 to 10 and in 23% of patients with scores of 11 to 15. After multivariate adjustment, lacunar stroke had an odds ratio of 3.1 (95% CI, 1.5 to 6.4) for an excellent outcome at 3 months.
CONCLUSIONS: The NIHSS score strongly predicts the likelihood of a patient’s recovery after stroke. A score of 
16 forecasts a high probability of death or severe disability whereas a score of 
6 forecasts a good recovery. Only the TOAST subtype of lacunar stroke predicts outcomes independent of the NIHSS score.
This article has been cited by other articles:
|
|
 |
|
  K. M. Barrett, Y. H. Ding, D. P. Wagner, D. F. Kallmes, K. C. Johnston, and for the ASAP Investigators Change in Diffusion-Weighted Imaging Infarct Volume Predicts Neurologic Outcome at 90 Days: Results of the Acute Stroke Accurate Prediction (ASAP) Trial Serial Imaging Substudy Stroke, July 1, 2009; 40(7): 2422 - 2427. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K.-c. Lin, Y.-h. Huang, Y.-w. Hsieh, and C.-y. Wu Potential Predictors of Motor and Functional Outcomes After Distributed Constraint-Induced Therapy for Patients With Stroke Neurorehabil Neural Repair, May 1, 2009; 23(4): 336 - 342. [Abstract] [PDF]
|
|
|
|
 |
|
 E. M. Arsava, R. Rahman, J. Rosand, J. Lu, E. E. Smith, N. S. Rost, A. B. Singhal, M. H. Lev, K. L. Furie, W. J. Koroshetz, et al. Severity of leukoaraiosis correlates with clinical outcome after ischemic stroke Neurology, April 21, 2009; 72(16): 1403 - 1410. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L.E. Cipriano, M.L. Steinberg, G.S. Gazelle, and R.G. Gonzalez Comparing and Predicting the Costs and Outcomes of Patients with Major and Minor Stroke Using the Boston Acute Stroke Imaging Scale Neuroimaging Classification System AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 703 - 709. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. V. Goldmakher, E. C.S. Camargo, K. L Furie, A. B. Singhal, L. Roccatagliata, E. F. Halpern, M. J. Chou, T. Biagini, W. S. Smith, G. J. Harris, et al. Hyperdense Basilar Artery Sign on Unenhanced CT Predicts Thrombus and Outcome in Acute Posterior Circulation Stroke Stroke, January 1, 2009; 40(1): 134 - 139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sato, K. Toyoda, T. Uehara, N. Toratani, C. Yokota, H. Moriwaki, H. Naritomi, and K. Minematsu Baseline NIH Stroke Scale Score predicting outcome in anterior and posterior circulation strokes Neurology, June 10, 2008; 70(24_Part_2): 2371 - 2377. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Torres-Mozqueda, J. He, I.B. Yeh, L.H. Schwamm, M.H. Lev, P.W. Schaefer, and R.G. Gonzalez An Acute Ischemic Stroke Classification Instrument That Includes CT or MR Angiography: The Boston Acute Stroke Imaging Scale AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1111 - 1117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-C. Diener, D. Schneider, Y. Lampl, N. M. Bornstein, A. Kozak, G. Rosenberg, and on Behalf of the Study Group DP-b99, a Membrane-Activated Metal Ion Chelator, as Neuroprotective Therapy in Ischemic Stroke Stroke, June 1, 2008; 39(6): 1774 - 1778. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. C. Lisle, K. M. Barrett, L. M. Gazoni, B. R. Swenson, C. D. Scott, A. Kazemi, J. A. Kern, B. B. Peeler, I. L. Kron, and K. C. Johnston Timing of Stroke After Cardiopulmonary Bypass Determines Mortality Ann. Thorac. Surg., May 1, 2008; 85(5): 1556 - 1563. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y Iguchi, K Kimura, K Kobayashi, Y Ueno, K Shibazaki, and T Inoue Microembolic signals at 48 hours after stroke onset contribute to new ischaemia within a week J. Neurol. Neurosurg. Psychiatry, March 1, 2008; 79(3): 253 - 259. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Meseguer, J. Labreuche, J. M. Olivot, H. Abboud, P. C. Lavallee, O. Simon, L. Cabrejo, A. Echeverria, I. F. Klein, M. Mazighi, et al. Determinants of outcome and safety of intravenous rt-PA therapy in the very old: a clinical registry study and systematic review Age Ageing, January 1, 2008; 37(1): 107 - 111. [Full Text] [PDF]
|
|
|
|
|
|
P. Mandava and T. A. Kent Intra-arterial therapies for acute ischemic stroke Neurology, June 12, 2007; 68(24): 2132 - 2139. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. del Zoppo and J. A. Koziol Recanalization and Stroke Outcome Circulation, May 22, 2007; 115(20): 2602 - 2605. [Full Text] [PDF]
|
|
|
|
|
|
R. Mikulik, M. Ribo, M. D. Hill, J. C. Grotta, M. Malkoff, C. Molina, M. Rubiera, R. Delgado-Mederos, J. Alvarez-Sabin, A. V. Alexandrov, et al. Accuracy of Serial National Institutes of Health Stroke Scale Scores to Identify Artery Status in Acute Ischemic Stroke Circulation, May 22, 2007; 115(20): 2660 - 2665. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Roquer, A. Ois, A. Rodriguez-Campello, M. Gomis, E. Munteis, J. Jimenez-Conde, E. Cuadrado-Godia, and J. E. Martinez-Rodriguez Atherosclerotic Burden and Early Mortality in Acute Ischemic Stroke Arch Neurol, May 1, 2007; 64(5): 699 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. I. Qureshi, M. F. K. Suri, J. Zhou, and A. A. Divani African American women have poor long-term survival following ischemic stroke. Neurology, November 14, 2006; 67(9): 1623 - 1629. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kunz, G. Hahn, D. Mucha, A. Muller, K.M. Barrett, R. von Kummer, and G. Gahn Echo-Enhanced Transcranial Color-Coded Duplex Sonography in the Diagnosis of Cerebrovascular Events: A Validation Study AJNR Am. J. Neuroradiol., November 1, 2006; 27(10): 2122 - 2127. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. V. Elkind, W. Tai, K. Coates, M. C. Paik, and R. L. Sacco High-sensitivity C-reactive protein, lipoprotein-associated phospholipase A2, and outcome after ischemic stroke. Arch Intern Med, October 23, 2006; 166(19): 2073 - 2080. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Hand, J. M. Wardlaw, C. S. Rivers, P. A. Armitage, M. E. Bastin, R. I. Lindley, and M. S. Dennis MR diffusion-weighted imaging and outcome prediction after ischemic stroke Neurology, April 25, 2006; 66(8): 1159 - 1163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Bruno, C. Saha, and L. S. Williams Using Change in the National Institutes of Health Stroke Scale to Measure Treatment Effect in Acute Stroke Trials Stroke, March 1, 2006; 37(3): 920 - 921. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Vancheri, M. Curcio, A. Burgio, S. Salvaggio, G. Gruttadauria, M.C. Lunetta, R. Dovico, and M. Alletto Impaired glucose metabolism in patients with acute stroke and no previous diagnosis of diabetes mellitus QJM, December 1, 2005; 98(12): 871 - 878. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Fischer, M. Arnold, K. Nedeltchev, C. Brekenfeld, P. Ballinari, L. Remonda, G. Schroth, and H. P. Mattle NIHSS Score and Arteriographic Findings in Acute Ischemic Stroke Stroke, October 1, 2005; 36(10): 2121 - 2125. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M S Mouradian, A Senthilselvan, G Jickling, J A McCombe, D J Emery, N Dean, and A Shuaib Intravenous rt-PA for acute stroke: comparing its effectiveness in younger and older patients J. Neurol. Neurosurg. Psychiatry, September 1, 2005; 76(9): 1234 - 1237. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Duncan, R. Zorowitz, B. Bates, J. Y. Choi, J. J. Glasberg, G. D. Graham, R. C. Katz, K. Lamberty, and D. Reker Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline Stroke, September 1, 2005; 36(9): e100 - e143. [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Goldstein and D. L. Simel Is This Patient Having a Stroke? JAMA, May 18, 2005; 293(19): 2391 - 2402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Kimura, K Minematsu, T Yamaguchi, and for the Japan Multicenter Stroke Investigators' Co Atrial fibrillation as a predictive factor for severe stroke and early death in 15 831 patients with acute ischaemic stroke J. Neurol. Neurosurg. Psychiatry, May 1, 2005; 76(5): 679 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G T Plant and K Landau Thrombolysis for central retinal artery occlusion J. Neurol. Neurosurg. Psychiatry, February 1, 2005; 76(2): 160 - 161. [Full Text] [PDF]
|
|
|
|
 |
|
 T. A. Glass, L. F. Berkman, E. F. Hiltunen, K. Furie, M. M. Glymour, M. E. Fay, and J. Ware The Families In Recovery From Stroke Trial (FIRST): Primary Study Results Psychosom Med, November 1, 2004; 66(6): 889 - 897. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Thijs More bad news about atrial fibrillation Eur. Heart J., October 1, 2004; 25(19): 1670 - 1671. [Full Text] [PDF]
|
|
|
|
|
|
D. Georgiadis, J. Oehler, S. Schwarz, V. Rousson, M. Hartmann, and S. Schwab Does acute occlusion of the carotid T invariably have a poor outcome? Neurology, July 13, 2004; 63(1): 22 - 26. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Cestari, D. M. Weine, K. S. Panageas, A. Z. Segal, and L. M. DeAngelis Stroke in patients with cancer: Incidence and etiology Neurology, June 8, 2004; 62(11): 2025 - 2030. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.-C. Chang, M.-C. Tseng, and T.-Y. Tan Prehospital Delay After Acute Stroke in Kaohsiung, Taiwan Stroke, March 1, 2004; 35(3): 700 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nakajima, K. Kimura, T. Ogata, T. Takada, M. Uchino, and K. Minematsu Relationships between Angiographic Findings and National Institutes of Health Stroke Scale Score in Cases of Hyperacute Carotid Ischemic Stroke AJNR Am. J. Neuroradiol., February 1, 2004; 25(2): 238 - 241. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Weimar, I.R. Konig, K. Kraywinkel, A. Ziegler, and H.C. Diener Age and National Institutes of Health Stroke Scale Score Within 6 Hours After Onset Are Accurate Predictors of Outcome After Cerebral Ischemia: Development and External Validation of Prognostic Models Stroke, January 1, 2004; 35(1): 158 - 162. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S J Allder, A R Moody, A L Martel, P S Morgan, G S Delay, J R Gladman, and G G Lennox Differences in the diagnostic accuracy of acute stroke clinical subtypes defined by multimodal magnetic resonance imaging J. Neurol. Neurosurg. Psychiatry, July 1, 2003; 74(7): 886 - 888. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. R. Crafton, A. N. Mark, and S. C. Cramer Improved understanding of cortical injury by incorporating measures of functional anatomy Brain, July 1, 2003; 126(7): 1650 - 1659. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.M. Wardlaw, P.A.G. Sandercock, and E. Berge Thrombolytic Therapy With Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke: Where Do We Go From Here? A Cumulative Meta-Analysis Stroke, June 1, 2003; 34(6): 1437 - 1442. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
|
|
Performance of a Statistical Model to Predict Stroke Outcome in the Context of a Large, Simple, Randomized, Controlled Trial of Feeding Stroke, January 1, 2003; 34(1): 127 - 133. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Schlegel;, S. J. Kolb, J. M. Luciano, J. M. Tovar, B. L. Cucchiara, D. S. Liebeskind, and S. E. Kasner Utility of the NIH Stroke Scale as a Predictor of Hospital Disposition Stroke, January 1, 2003; 34(1): 134 - 137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Tirschwell, W.T. Longstreth Jr, K. J. Becker, R. E. Gammans Sr, L. A. Sabounjian, S. Hamilton, and L. B. Morgenstern Shortening the NIH Stroke Scale for Use in the Prehospital Setting Stroke, December 1, 2002; 33(12): 2801 - 2806. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.M. Wardlaw, S.L. Keir, M.E. Bastin, P.A. Armitage, and A.K. Rana Is diffusion imaging appearance an independent predictor of outcome after ischemic stroke? Neurology, November 12, 2002; 59(9): 1381 - 1387. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.-C. Chang, M.-C. Tseng, H.-H. Weng, Y.-H. Lin, C.-W. Liou, and T.-Y. Tan Prediction of Length of Stay of First-Ever Ischemic Stroke Stroke, November 1, 2002; 33(11): 2670 - 2674. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G Stankovic, F Liistro, S Moshiri, C Briguori, N Corvaja, G Gimelli, A Chieffo, M Montorfano, L Finci, V Spanos, et al. Carotid artery stenting in the first 100 consecutive patients: results and follow up Heart, October 1, 2002; 88(4): 381 - 386. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Bak, S. H. Sindrup, T. Alslev, O. Kristensen, K. Christensen, and D. Gaist Cessation of Smoking After First-Ever Stroke: A Follow-Up Study Stroke, September 1, 2002; 33(9): 2263 - 2269. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. N. Fink, M. H. Selim, S. Kumar, B. Silver, I. Linfante, L. R. Caplan, and G. Schlaug Is the Association of National Institutes of Health Stroke Scale Scores and Acute Magnetic Resonance Imaging Stroke Volume Equal for Patients With Right- and Left-Hemisphere Ischemic Stroke? Stroke, April 1, 2002; 33(4): 954 - 958. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Albers, L. B. Goldstein, D. Hall, L. M. Lesko, and for the Aptiganel Acute Stroke Investigators Aptiganel Hydrochloride in Acute Ischemic Stroke: A Randomized Controlled Trial JAMA, December 5, 2001; 286(21): 2673 - 2682. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. Kilpatrick, H. Yonas, S. Goldstein, A. B. Kassam, J. M. Gebel Jr, L. R. Wechsler, C. A. Jungreis, and M. B. Fukui CT-Based Assessment of Acute Stroke: CT, CT Angiography, and Xenon-Enhanced CT Cerebral Blood Flow Stroke, November 1, 2001; 32(11): 2543 - 2549. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. A. Copen, L. H. Schwamm, R. G. Gonzalez, O. Wu, C. B. Harmath, P. W. Schaefer, W. J. Koroshetz, and A. G. Sorensen Ischemic Stroke: Effects of Etiology and Patient Age on the Time Course of the Core Apparent Diffusion Coefficient Radiology, October 1, 2001; 221(1): 27 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Gladstone and S. E. Black Update on intravenous tissue plasminogen activator for acute stroke: from clinical trials to clinical practice Can. Med. Assoc. J., August 1, 2001; 165(3): 311 - 317. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gotoh, Y. Terayama, and T. Amano Development of a Novel, Weighted, Quantifiable Stroke Scale: Japan Stroke Scale Stroke, August 1, 2001; 32(8): 1800 - 1807. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Krieger, M. A. De Georgia, A. Abou-Chebl, J. C. Andrefsky, C. A. Sila, I. L. Katzan, M. R. Mayberg, and A. J. Furlan Cooling for Acute Ischemic Brain Damage (COOL AID): An Open Pilot Study of Induced Hypothermia in Acute Ischemic Stroke Stroke, August 1, 2001; 32(8): 1847 - 1854. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Labovitz, W. Allen Hauser, and R. L. Sacco Prevalence and predictors of early seizure and status epilepticus after first stroke Neurology, July 24, 2001; 57(2): 200 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Recommendations for Clinical Trial Evaluation of Acute Stroke Therapies Stroke, July 1, 2001; 32(7): 1598 - 1606. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Uchino, D. Billheimer, and S. C. Cramer Entry Criteria and Baseline Characteristics Predict Outcome in Acute Stroke Trials Stroke, April 1, 2001; 32(4): 909 - 916. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. N. Thijs, M. G. Lansberg, C. Beaulieu, M. P. Marks, M. E. Moseley, and G. W. Albers Is Early Ischemic Lesion Volume on Diffusion-Weighted Imaging an Independent Predictor of Stroke Outcome? : A Multivariable Analysis Stroke, November 1, 2000; 31(11): 2597 - 2602. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Herrmann, P. Vos, M. T. Wunderlich, C. H. M. M. de Bruijn, and K. J. B. Lamers Release of Glial Tissue-Specific Proteins After Acute Stroke : A Comparative Analysis of Serum Concentrations of Protein S-100B and Glial Fibrillary Acidic Protein Stroke, November 1, 2000; 31(11): 2670 - 2677. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Frankel, L. B. Morgenstern, T. Kwiatkowski, M. Lu, B. C. Tilley, J. P. Broderick, R. Libman, S. R. Levine, and T. Brott Predicting prognosis after stroke: A placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial Neurology, October 10, 2000; 55(7): 952 - 959. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Hinchey and C. Benesch Thrombolytic Therapy in Patients With Acute Ischemic Stroke Arch Neurol, October 1, 2000; 57(10): 1430 - 1436. [Full Text] [PDF]
|
|
|
|
|
|
C. Oppenheim, Y. Samson, R. Manai, T. Lalam, X. Vandamme, S. Crozier, A. Srour, P. Cornu, D. Dormont, G. Rancurel, et al. Prediction of Malignant Middle Cerebral Artery Infarction by Diffusion-Weighted Imaging Stroke, September 1, 2000; 31(9): 2175 - 2181. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. W. Parsons, T. Li, P. A. Barber, Q. Yang, D. G. Darby, P. M. Desmond, R. P. Gerraty, B. M. Tress, and S. M. Davis Combined 1H MR spectroscopy and diffusion-weighted MRI improves the prediction of stroke outcome Neurology, August 22, 2000; 55(4): 498 - 506. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Initial Stroke Scale Score Predicts Patient Outcome Journal Watch Emergency Medicine, September 1, 1999; 1999(901): 23 - 23. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
