Abstract Details

Title NIHSS Score Subsets Are Superior to Total NIHSS Score in Predicting Outcomes of Patients with Mild Deficits

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 188

Objective

Background BACKGROUND: Although NIHSS score is useful in predicting long term outcome after stroke, its usefulness in mild strokes is uncertain, potentially causing variability in t-PA use in this group.

Design/Methods DESIGN/METHODS: We reviewed the prospective database of all stroke patients who received t-PA at our PSC and through the telestroke network for clinical and laboratory parameters, NIHSS and subset scores, and outcome obtained at 3-months via telephone interview. Mild strokes were defined as admission NIHSS score ? 8. The three LOC subsets (1 a, b, c) were combined into one while other subscores represented a category each on its own. Subsets were divided based on the individual scores (? 1 and > 1). Patients were divided into two groups based on 3-month outcome: good (mRS ? 1) or poor (mRS > 1). We performed univariate and multivariate regression analyses to determine predictors of poor outcome.

Results RESULTS: 312 patients were identified between November 2008 and June 2012; 114 patients had mild deficits. On univariate analysis, factors predicting poor outcome were LOC > 1 (30% vs. 10%, p=0.014), Motor Leg Score > 1 (40% vs. 13%, p=0.003), atrial fibrillation (20% vs. 5%, p=0.002), and age ? 80 years (30% vs. 11%, p=0.002). Other clinical and laboratory parameters and median and mean NIHSS scores and other NIHSS subscores were similar between the two groups. On regression analysis, factors predicting poor outcome were LOC > 1 (OR = 6.7,CI [2.2 - 20.3],p = 0.001) and Motor Leg Score > 1 (OR = 6.9,CI [2.0 - 23.7],p = 0.002).

Conclusions CONCLUSIONS: LOC and Motor Leg subset scores better predict outcome in patients with mild deficits than the total NIHSS score. This helps triaging patients with mild deficits who may benefit from thrombolytic therapy.

Authors/Disclosures
Shadi Yaghi, MD (Hackensack Meridian Health) PRESENTER	Dr. Yaghi has nothing to disclose.
Nicolas A. Bianchi, MD (Emory University)	Dr. Bianchi has received personal compensation in the range of $0-$499 for serving as a Consultant for Innovation Hub Enterprises, LLC. The institution of Dr. Bianchi has received research support from Emory Medical Care Foundation.
	No disclosure on file
	No disclosure on file
Fernando Dangond, MD, FAAN	Dr. Dangond has received personal compensation in the range of $1,000,000+ for serving as a Head, Global Clinical Development (employee for 12 years) with EMD Serono.
	No disclosure on file
Archana Hinduja, MD	Dr. Hinduja has nothing to disclose.

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