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Abstract
Purpose The modified Rankin Scale (mRS) at 90 days has become a standard functional outcome measure in clinical practice and in acute ischemic stroke trials. An early prognostic score during the stroke hospitalization will aid physicians in explaining the natural history of the disease to the patient’s families, as well as assist in clinical trials of newer stroke medical devices being completed faster and more cost-effectively. The purpose of this study is to look at how NIHSS scores at 24 h and at 7-days/discharge correlated with 90-day functional outcome.
Methods FIRST is a prospective natural history study (N = 93) enrolling patients that are eligible for but untreated by endovascular therapy and either ineligible or refractory to IV rtPA. Spearman’s rank correlations were utilized in measuring the association between NIHSS and ASPECTS, trichotomized as small (8–10), medium (5–7), and large (0–4), as well as 90-day mRS as a continuous variable. Logistic regression was used in a multivariate analysis to assess dichotomized mRS (0–2 vs. 3–6) with the covariates of age (< 70), baseline NIHSS (<20), and trichotomized baseline ASPECTS.
Results Mean NIHSS score at hospital presentation was 19.3+6.2 (N = 93). Higher NIHSS 24-hour (r = 0.54, p < 0.0001), and 7-day scores (r = 0.72, p < 0.0001) were associated with higher 90 day mRS scores displaying a strong relationship (Figure 1) between NIHSS scores at 24 h and 7 day with 90-day good functional outcomes (mRS 0–2). The baseline ASPECTS score was not significantly (p = 0.21) correlated with 90 day mRS, however the baseline ASPECTS scores did have a significant correlation (Table 1) with NIHSS at 24 h and 7 days (p = 0.0012 and 0.0279, respectively).
Conclusion NIHSS at 24 h and at 7 days or discharge had a strong correlation with 90-day functional outcome. This study provides invaluable information for stroke physicians to be able to prognosticate when they talk to patients and family members at the end of hospitalization. In addition, this landmark study will help recruitment and completion of future medical device trials on stroke patients much faster and cost-effectively, thereby bringing down healthcare costs and facilitating newer medical devices for stroke treatment to become available to patients sooner.
Correlation between ASPECTS and NIHSS
Disclosures V. Janardhan: None. T. Shams: None. A. Yoo: None. D. Frei: None. K. Patel: None. R. Gianatasio: None. A. Venizelos: None. L. Ammar: 5; C; Penumbra, Inc. S. Kuo: 5; C; Penumbra, Inc. S. Hak: 5; C; Penumbra, Inc. N. Nguyen: 5; C; Penumbra, Inc. H. Buell: 5; C; Penumbra, Inc. L. Barraza: 5; C; Penumbra, Inc. A. Bose: 4; C; Penumbra, Inc. 5; C; Penumbra, Inc. S. Sit: 4; C; Penumbra, Inc. 5; C; Penumbra, Inc.
mRS 90 day vs. 24 hr NIHSS and 7-day NIHSS