BACKGROUND: Physicians are often asked to predict outcome after acute stroke. Very little information is available that can reliably predict the likelihood of severe disability or death. OBJECTIVE: To develop a practical method for predicting a poor outcome after acute ischemic stroke. METHODS: Data from the placebo arms of Parts 1 and 2 of the National Institute of Neurological Disorders and Stroke rt-PA [recombinant tissue plasminogen activator] Stroke Trial were used to identify variables that could predict a poor outcome, defined as moderately severe disability, severe disability, or death (Modified Rankin Scale score >3) 3 months after stroke. RESULTS: Baseline variables that predicted poor outcome were the NIH Stroke Scale (NIHSS) >17 plus atrial fibrillation, yielding a positive predictive value (PPV) of 96% (95% CI, 88 to 100%). The best predictor at 24 hours was NIHSS >22, yielding a PPV of 98% (95% CI, 93 to 100%). The best predictor at 7 to 10 days was NIHSS >16, yielding a PPV of 92% (95% CI, 85 to 99%). CONCLUSIONS:Patients with a severe neurologic deficit after acute ischemic stroke, as measured by the NIHSS, have a poor prognosis. During the first week after acute ischemic stroke, it is possible to identify a subset of patients who are highly likely to have a poor outcome. These findings require confirmation in a separate study.
RCT Entities:
BACKGROUND: Physicians are often asked to predict outcome after acute stroke. Very little information is available that can reliably predict the likelihood of severe disability or death. OBJECTIVE: To develop a practical method for predicting a poor outcome after acute ischemic stroke. METHODS: Data from the placebo arms of Parts 1 and 2 of the National Institute of Neurological Disorders and Stroke rt-PA [recombinant tissue plasminogen activator] Stroke Trial were used to identify variables that could predict a poor outcome, defined as moderately severe disability, severe disability, or death (Modified Rankin Scale score >3) 3 months after stroke. RESULTS: Baseline variables that predicted poor outcome were the NIH Stroke Scale (NIHSS) >17 plus atrial fibrillation, yielding a positive predictive value (PPV) of 96% (95% CI, 88 to 100%). The best predictor at 24 hours was NIHSS >22, yielding a PPV of 98% (95% CI, 93 to 100%). The best predictor at 7 to 10 days was NIHSS >16, yielding a PPV of 92% (95% CI, 85 to 99%). CONCLUSIONS:Patients with a severe neurologic deficit after acute ischemic stroke, as measured by the NIHSS, have a poor prognosis. During the first week after acute ischemic stroke, it is possible to identify a subset of patients who are highly likely to have a poor outcome. These findings require confirmation in a separate study.
Authors: Liqiong Fan; Sharon D Yeatts; Lydia D Foster; Pooja Khatri; Thomas Tomsick; Joseph P Broderick; Yuko Y Palesch Journal: Interv Neurol Date: 2016-10-19
Authors: Narayanaswamy Venketasubramanian; Chun Fan Lee; Sherry H Young; San San Tay; Thirugnanam Umapathi; Annabelle Y Lao; Herminigildo H Gan; Alejandro C Baroque Ii; Jose C Navarro; Hui Meng Chang; Joel M Advincula; Sombat Muengtaweepongsa; Bernard P L Chan; Carlos L Chua; Nirmala Wijekoon; H Asita de Silva; John Harold B Hiyadan; Nijasri C Suwanwela; K S Lawrence Wong; Niphon Poungvarin; Gaik Bee Eow; Christopher L H Chen Journal: Cerebrovasc Dis Date: 2016-11-15 Impact factor: 2.762
Authors: Carol L Moore; Mei Lu; Faiqa Cheema; Paola Osaki-Kiyan; Mary Beth Perri; Susan Donabedian; Nadia Z Haque; Marcus J Zervos Journal: Antimicrob Agents Chemother Date: 2011-08-08 Impact factor: 5.191
Authors: M S Mouradian; A Senthilselvan; G Jickling; J A McCombe; D J Emery; N Dean; A Shuaib Journal: J Neurol Neurosurg Psychiatry Date: 2005-09 Impact factor: 10.154