Neurology 1999;53:126
© 1999 American Academy of Neurology
Articles
Baseline NIH Stroke Scale score strongly predicts outcome after stroke
A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)
H. P. Adams, Jr., MD,
P. H. Davis, MD,
E. C. Leira, MD,
K.-C. Chang, MD,
B. H. Bendixen, PhD, MD,
W. R. Clarke, PhD,
R. F. Woolson, PhD and
M. D. Hansen, MS
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.
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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]
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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]
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J. A. Hinchey and C. Benesch
Thrombolytic Therapy in Patients With Acute Ischemic Stroke
Arch Neurol,
October 1, 2000;
57(10):
1430 - 1436.
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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]
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[PDF]
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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]
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Initial Stroke Scale Score Predicts Patient Outcome
Journal Watch Emergency Medicine,
September 1, 1999;
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