Abstract Details

Title Redefining Stroke Severity in the Posterior Circulation: Comparative Outcome Prediction Using NIHSS and POST-NIHSS

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-014

Objective

To compare the predictive performance of the National Institutes of Health Stroke Scale (NIHSS) and the Posterior NIH Stroke Scale (POST-NIHSS) for assessing severity and outcome in posterior circulation stroke (PCS).

Background The NIHSS was designed for anterior circulation syndromes and underrepresents posterior features. This leads to systematic underestimation of PCS severity. The POST-NIHSS incorporates additional posterior-specific domains, offering a more comprehensive and anatomically accurate reflection of neurological impairment across the brainstem and cerebellar regions.

Design/Methods

A cross-sectional observational study was conducted on 243 PCS patients. Stroke severity was recorded at admission using both NIHSS and POST-NIHSS, and 90-day outcomes were measured with the modified Rankin Scale (mRS). Demographic details, addictions and comorbidities were noted. Correlation between each scale and mRS was analyzed with Spearman’s rho, and discriminative ability for poor outcome (mRS ≥ 3) was assessed with receiver operating characteristic (ROC) curves.

Results Mean age was 59.6 ± 14.7 years; 71% were male. Mean NIHSS was 4.8 ± 4.3 and POST-NIHSS 9.1 ± 7.6. Poor functional outcome occurred in 34.6% of patients. The adjusted logistic regression for poor functional outcome (mRS > 2), prior CVA/TIA was independently associated with higher odds of poor outcome (OR 1.97, 95% CI 1.01–3.82; p = 0.044).Both scores correlated significantly with 90-day mRS (NIHSS ρ = 0.538, POST-NIHSS ρ = 0.600; p < 0.001). The POST-NIHSS demonstrated superior predictive accuracy for poor outcome (AUC 0.844 [95% CI 0.786–0.902]) compared with NIHSS (AUC 0.780 [0.714–0.847]).

Conclusions

The POST-NIHSS more accurately captures the clinical severity of posterior circulation strokes, and we demonstrate a stronger correlation with functional outcome compared with the conventional NIHSS. Incorporation of posterior-specific domains enhances prognostic precision and can significantly improve acute triage, therapeutic decision-making, trial eligibility criteria, and long-term outcome prediction in posterior circulation stroke cohorts. ITS TIME TO UPGRADE NIHSS!

Authors/Disclosures
Pranav J. Mehta PRESENTER	Mr. Mehta has nothing to disclose.
Sankar P. Gorthi, MD, FAAN (Bharati hospital)	Dr. Gorthi has nothing to disclose.
Dulari Gupta, MD, MBBS	Dr. Gupta has nothing to disclose.
Neha D. Mohite, Sr., MD	Dr. Mohite has nothing to disclose.

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