Abstract Details

Title Identifying optimal cut points of National Institutes of Health Stroke Scale to Predict Mortality: A Population-based Assessment

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 6-016

Objective We sought to identify the optimal cut-points of NIHSS at initial presentation that correlate with higher 30-day mortality.

Background Ischemic stroke is the 5^th leading cause of death in the US. As a measure of stroke severity, initial NIHSS has been used to predict clinical outcome.

Design/Methods In 2005, 2010, and 2015 all hospitalized, first acute ischemic stroke events occurring within the Greater Cincinnati 5-county area were ascertained. Potential cases underwent chart abstraction and physician adjudication, including assignment of a retrospective NIHSS score based on clinical findings at initial presentation. Descriptive statistics for NIHSS were estimated by study year, demographics, and medical history. Data regarding mortality was obtained from the National Death Index. The Contal and O’Quigley method based on a modified log-rank test statistic was used to determine cut-points of the NIHSS score associated with 30-day mortality, and hazard ratios were obtained from Cox models with adjustment for sex, race, and age.

Results In 2005, 2010, and 2015 there were 1704, 1818, 1852 ischemic stroke events, respectively. Thirty-day mortality rates were 10.5%, 9.6%, 9.0%, respectively. Optimal cut-points of NIHSS <9, 9-16 and >16 were identified. Across all 3 periods, 3431 (84.5%) of cases had NIHSS 0-8, 352 (8.7%) had NIHSS 9-16 and 274 (6.8%) >16. Kaplan Meier Survival Curves for the 3 NIHSS groups are shown in the Figure. NIHSS >16 at initial presentation was associated with a 15 fold (HR with 95% CI: 13, 19) increase in the risk of death at 30-days compared to those with NIHSS <9.

Conclusions NIH Stroke Scale scores are a predictor of mortality, with higher NIHSS scores having higher risk of death. The cut points reported identify subgroups of stroke patients with dramatically different prognoses. Future studies should assess if this excess mortality risk among severe strokes persists after more widespread implementation of thrombectomy beyond 2015.

Authors/Disclosures
Robert Stanton II, MD (University of Cincinnati Neurology) PRESENTER	The institution of Dr. Stanton has received research support from NIH.
David Robinson, MD (University of Cincinnati)	The institution of Dr. Robinson has received research support from NIH. The institution of Dr. Robinson has received research support from UC.
Mathew J. Reeves, PhD, BVSc	Mathew J. Reeves, PhD, BVSc has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association.
Lili Ding	No disclosure on file
	No disclosure on file
Mary Haverbusch	No disclosure on file
Kathleen Alwell	No disclosure on file
Opeolu Adeoye	No disclosure on file
Elisheva R. Coleman, MD (University of Chicago Medical Center)	Dr. Coleman has nothing to disclose.
Felipe De Los Rios La Rosa, MD (Miami Neuroscience Institute)	Dr. De Los Rios La Rosa has nothing to disclose.
Stacie L. Demel, DO (University of Cincinnati Medical Center)	Dr. Demel has nothing to disclose.
Simona Ferioli, MD (UCMC)	Dr. Ferioli has nothing to disclose.
Matthew L. Flaherty, MD	Dr. Flaherty has received personal compensation for serving as an employee of Sense Diagnostics, Inc. Dr. Flaherty has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boeringher Engelheim. Dr. Flaherty has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for CSL Behring. Dr. Flaherty has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Alexion. Dr. Flaherty has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. Dr. Flaherty has stock in Sense Diagnostics, Inc. The institution of Dr. Flaherty has received research support from NINDS. Dr. Flaherty has received intellectual property interests from a discovery or technology relating to health care.
Adam S. Jasne, MD (Yale)	Dr. Jasne has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis.
Pooja Khatri, MD, FAAN (Univ of Cincinnati/Dept of Neuro)	The institution of Dr. Khatri has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lumosa. Dr. Khatri has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bayer. The institution of Dr. Khatri has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Diamedica. Dr. Khatri has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Basking Biosciences. Dr. Khatri has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Khatri has received research support from Cerenovus. Dr. Khatri has received publishing royalties from a publication relating to health care.
Jason S. Mackey, MD	Dr. Mackey has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for legal firms. The institution of Dr. Mackey has received research support from PCORI.
Sharyl R. Martini, MD, PhD (VHA Neurology)	Dr. Martini has nothing to disclose.
Eva A. Mistry	No disclosure on file
Sabreena J. Slavin, MD (University of Kansas Hospital)	Dr. Slavin has nothing to disclose.
Michael J. Star, MD (Star Neurology)	Dr. Star has nothing to disclose.
Daniel Woo, MD, FAAN (University at Buffalo)	The institution of Dr. Woo has received research support from NIH.
Kyle Walsh	No disclosure on file
Brett M. Kissela, MD, MS, FAAN (University of Cincinnati Hospital)	The institution of Dr. Kissela has received research support from NIH/NINDS. Dr. Kissela has a non-compensated relationship as a Board Member with AHA Regional Board that is relevant to AAN interests or activities.
Dawn O. Kleindorfer, MD, FAAN (University of Michigan Department of Neurology)	Dr. Kleindorfer has nothing to disclose.

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