Skip to main content
AAN.com
Articles
July 1, 1999

Baseline NIH Stroke Scale score strongly predicts outcome after stroke
A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)

July 1, 1999 issue
53 (1) 126

Abstract

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.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
The NINDS t-PA Stroke Study Group.Generalized efficacy of t-PA for acute stroke. Subgroup analysis of the NINDS t-PA Stroke Trial. Stroke 1997;28:2119–2125.
2.
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.
3.
Fiorelli M, Alperovitch A, Argentino C, 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.
4.
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.
5.
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.
6.
Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction. A clinical examination scale. Stroke 1989;20:864–870.
7.
Goldstein LR, Bertels C, Davis JN. Interrater reliability of the NIH Stroke Scale. Arch Neurol 1989;46:660–662.
8.
Wityk RJ, Pessin MS, Kaplan RF, Caplan LR. Serial assessment of acute stroke using the NIH Stroke Scale. Stroke 1994;25:362–365.
9.
Donnan GA, Dewey H, Davis SH, Thrift A. Acute brain infarction. Early changes in neurologic status. Cerebrovasc Dis 1997;7:6–9.
10.
Goldstein LR, Samsa GP. Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial. Stroke 1997;28:307–310.
11.
Caplan LR. New therapies for stroke. Arch Neurol 1997;54:1222–1224.
12.
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. Stroke 1993;24:35–41.
13.
The Publications Committee for the Trial of Org 10172 in Acute Stroke Treatment (TOAST) investigators.Low molecular weight heparinoid Org 10172 (danaparoid), and outcome after acute ischemic stroke. A randomized, controlled trial. JAMA 1998;279:1265–1272.
14.
Albanese MA, Clarke WR, Adams HP Jr, Woolson RF, TOAST investigators. Ensuring reliability of outcome measures in multicenter clinical trials of treatments for acute ischemic stroke. Stroke 1994;25:1746–1751.
15.
Gordon DL, Bendixen BH, Adams HP Jr, Kappelle LJ, Woolson RF, TOAST investigators. Interphysician agreement in the diagnosis of subtypes of acute ischemic stroke. Implications for clinical trials. Neurology 1993;43:1021–1027.
16.
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521–1526.
17.
Hacke W, Kaste M, Fieschi C, et al. Randomized double-blind, placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS–II). Lancet 1998;352:1245–1251.
18.
Madden KP, Karanjia PN, Adams HP Jr, Clarke WR, TOAST investigators. Accuracy of initial stroke subtype diagnosis in the TOAST study. Neurology 1995;45:1975–1979.
19.
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.
20.
Warach S, Dashe JF, Edelmann RR. Clinical outcomes in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging. A preliminary analysis. J Cereb Blood Flow Metab 1996;16:53–59.
21.
Lutsep HL, Albers GW, DeCrespigny A, Kamat GN, Marks MP, Moseley ME. Clinical utility of diffusion-weighted magnetic resonance imaging in the assessment of ischemic stroke. Ann Neurol 1997;41:574
22.
Koroshetz WJ, Gonzalez G. Diffusion-weighted MRI : an ECG for “brain attack”? Ann Neurol 1997;41:565–566.
23.
Lovblad KO, Baird AE, Schlaug G, et al. Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlates with clinical outcome. Ann Neurol 1997;42:164–170.
24.
Powers WJ, Zivin J. Magnetic resonance imaging in acute stroke. Not ready for prime time. Neurology 1998;50:842–843.

Information & Authors

Information

Published In

Neurology®
Volume 53Number 1July 1, 1999
Pages: 126
PubMed: 10408548

Publication History

Received: July 17, 1998
Accepted: February 5, 1999
Published online: July 1, 1999
Published in print: July 1, 1999

Permissions

Request permissions for this article.

Authors

Affiliations & Disclosures

H.P. Adams, Jr., MD
From the Division of Cerebrovascular DiseasesDepartment 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.
P.H. Davis, MD
From the Division of Cerebrovascular DiseasesDepartment 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.
E.C. Leira, MD
From the Division of Cerebrovascular DiseasesDepartment 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.
K.-C. Chang, MD
From the Division of Cerebrovascular DiseasesDepartment 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.
B.H. Bendixen, PhD, MD
From the Division of Cerebrovascular DiseasesDepartment 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.
W.R. Clarke, PhD
From the Division of Cerebrovascular DiseasesDepartment 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.
R.F. Woolson, PhD
From the Division of Cerebrovascular DiseasesDepartment 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.
M.D. Hansen, MS
From the Division of Cerebrovascular DiseasesDepartment 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.

Notes

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: [email protected]

Metrics & Citations

Metrics

Citations

Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. Derivation and Validation of a Scoring System for Predicting Poor Outcome After Posterior Circulation Ischemic Stroke in China, Neurology, 102, 11, (2024)./doi/10.1212/WNL.0000000000209312
    Abstract
  2. Explanatory Power and Prognostic Implications of Factors Associated with Troponin Elevation in Acute Ischemic Stroke, Journal of Stroke, 25, 1, (141-150), (2023).https://doi.org/10.5853/jos.2022.02012
    Crossref
  3. Prognostic Role of Optic Nerve Sheath Diameter in Stroke in Emergency Department, A Case Control Study, Nigerian Journal of Clinical Practice, 26, 7, (863-870), (2023).https://doi.org/10.4103/njcp.njcp_1770_21
    Crossref
  4. Predictors of Short-Term Mortality in Patients with Ischemic Stroke, Medicina, 59, 6, (1142), (2023).https://doi.org/10.3390/medicina59061142
    Crossref
  5. From Admission to Discharge: Predicting National Institutes of Health Stroke Scale Progression in Stroke Patients Using Biomarkers and Explainable Machine Learning, Journal of Personalized Medicine, 13, 9, (1375), (2023).https://doi.org/10.3390/jpm13091375
    Crossref
  6. Actigraphic Sensors Describe Stroke Severity in the Acute Phase: Implementing Multi-Parametric Monitoring in Stroke Unit, Journal of Clinical Medicine, 12, 3, (1178), (2023).https://doi.org/10.3390/jcm12031178
    Crossref
  7. Functional and Cognitive Occupational Therapy (FaCoT) Improves Self-Efficacy and Behavioral–Emotional Status of Individuals with Mild Stroke; Analysis of Secondary Outcomes, International Journal of Environmental Research and Public Health, 20, 6, (5052), (2023).https://doi.org/10.3390/ijerph20065052
    Crossref
  8. Contributing Factors to the Burden on Primary Family Caregivers of Stroke Survivors in South Korea, International Journal of Environmental Research and Public Health, 20, 3, (2760), (2023).https://doi.org/10.3390/ijerph20032760
    Crossref
  9. Derivation and Validation of a New Visceral Adiposity Index for Predicting Short-Term Mortality of Patients with Acute Ischemic Stroke in a Chinese Population, Brain Sciences, 13, 2, (297), (2023).https://doi.org/10.3390/brainsci13020297
    Crossref
  10. Stroke profile and care during the COVID-19 pandemic: What changed and what did not? A prospective cohort from Joinville, Brazil, Frontiers in Neurology, 14, (2023).https://doi.org/10.3389/fneur.2023.1122875
    Crossref
  11. See more
Loading...

View Options

Get Access

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

Purchase this article to get full access to it.

Purchase Access, $39 for 24hr of access

View options

Full Text

View Full Text

Full Text HTML

View Full Text HTML

Media

Figures

Other

Tables

Share

Share

Share article link

Share