Prognostic value of acute National Institutes of Health Stroke Scale Items on disability: a registry study of first-ever stroke in the western part of Sweden
Objectives We aimed to study how the individual items of the National Institutes of Health Stroke Scale (NIHSS) at admission predict functional independence 3 months post-stroke in patients with first-ever stroke.Setting This registry-based study used data from two Swedish stroke registers (Riksstro...
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BMJ Publishing Group
2023-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/12/e080007.full |
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| author | Katharina S Sunnerhagen Hege Ihle Hansen Tamar Abzhandadze Haakon Ihle-Hansen Guri Hagberg Malin Reinholdsson |
| author_facet | Katharina S Sunnerhagen Hege Ihle Hansen Tamar Abzhandadze Haakon Ihle-Hansen Guri Hagberg Malin Reinholdsson |
| author_sort | Katharina S Sunnerhagen |
| collection | DOAJ |
| description | Objectives We aimed to study how the individual items of the National Institutes of Health Stroke Scale (NIHSS) at admission predict functional independence 3 months post-stroke in patients with first-ever stroke.Setting This registry-based study used data from two Swedish stroke registers (Riksstroke, the mandatory national quality register for stroke care in Sweden, and Väststroke, a local quality stroke register in Gothenburg).Participants This study included patients with first-ever acute stroke admitted from November 2014 to August 2018, with available NIHSS at admission and modified Rankin Scale (mRS) at 3-month follow-up.Primary outcome The primary outcome variable was mRS≤1 (defined as an excellent outcome) at 3-month follow-up.Results We included 1471 patients, mean age was 72 (± 14.5) years, 48% were female, and 66% had mild strokes (NIHSS≤3). In adjusted binary logistic regression analysis, the NIHSS items impaired right motor arm and leg, and impairment in visual field, reduced the odds of an excellent outcome at 3 months ((OR 0.60 (95% CI 0.37 to 0.98), OR 0.60 (95% CI 0.37 to 0.97), and OR 0.65 (95% CI 0.45 to 0.94)). When exploring the effect size of associations between NIHSS items and mRS≤1 p, orientation, language and right leg motor had the largest yet small association.Conclusions Stroke patients with scores on the NIHSS items right motor symptoms or visual field at admission are less likely to have an excellent outcome at 3 months. Clinicians should consider the NIHSS items affected, not only the total NIHSS score, both in treatment guidance and prognostics. |
| format | Article |
| id | doaj-art-f225afa958544a358c5a540b2ece00ff |
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| issn | 2044-6055 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-f225afa958544a358c5a540b2ece00ff2025-08-20T01:47:38ZengBMJ Publishing GroupBMJ Open2044-60552023-12-01131210.1136/bmjopen-2023-080007Prognostic value of acute National Institutes of Health Stroke Scale Items on disability: a registry study of first-ever stroke in the western part of SwedenKatharina S Sunnerhagen0Hege Ihle Hansen1Tamar Abzhandadze2Haakon Ihle-Hansen3Guri Hagberg4Malin Reinholdsson5Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Goteborg, SwedenOslo Stroke Unit, Neurological Department, Oslo University Hospital, Ullevål, Oslo, NorwayDepartment of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, SwedenDepartment of Medicine, Vestre Viken Hospital Trust, Drammen, NorwayInstitute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, NorwayDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Goteborg, SwedenObjectives We aimed to study how the individual items of the National Institutes of Health Stroke Scale (NIHSS) at admission predict functional independence 3 months post-stroke in patients with first-ever stroke.Setting This registry-based study used data from two Swedish stroke registers (Riksstroke, the mandatory national quality register for stroke care in Sweden, and Väststroke, a local quality stroke register in Gothenburg).Participants This study included patients with first-ever acute stroke admitted from November 2014 to August 2018, with available NIHSS at admission and modified Rankin Scale (mRS) at 3-month follow-up.Primary outcome The primary outcome variable was mRS≤1 (defined as an excellent outcome) at 3-month follow-up.Results We included 1471 patients, mean age was 72 (± 14.5) years, 48% were female, and 66% had mild strokes (NIHSS≤3). In adjusted binary logistic regression analysis, the NIHSS items impaired right motor arm and leg, and impairment in visual field, reduced the odds of an excellent outcome at 3 months ((OR 0.60 (95% CI 0.37 to 0.98), OR 0.60 (95% CI 0.37 to 0.97), and OR 0.65 (95% CI 0.45 to 0.94)). When exploring the effect size of associations between NIHSS items and mRS≤1 p, orientation, language and right leg motor had the largest yet small association.Conclusions Stroke patients with scores on the NIHSS items right motor symptoms or visual field at admission are less likely to have an excellent outcome at 3 months. Clinicians should consider the NIHSS items affected, not only the total NIHSS score, both in treatment guidance and prognostics.https://bmjopen.bmj.com/content/13/12/e080007.full |
| spellingShingle | Katharina S Sunnerhagen Hege Ihle Hansen Tamar Abzhandadze Haakon Ihle-Hansen Guri Hagberg Malin Reinholdsson Prognostic value of acute National Institutes of Health Stroke Scale Items on disability: a registry study of first-ever stroke in the western part of Sweden BMJ Open |
| title | Prognostic value of acute National Institutes of Health Stroke Scale Items on disability: a registry study of first-ever stroke in the western part of Sweden |
| title_full | Prognostic value of acute National Institutes of Health Stroke Scale Items on disability: a registry study of first-ever stroke in the western part of Sweden |
| title_fullStr | Prognostic value of acute National Institutes of Health Stroke Scale Items on disability: a registry study of first-ever stroke in the western part of Sweden |
| title_full_unstemmed | Prognostic value of acute National Institutes of Health Stroke Scale Items on disability: a registry study of first-ever stroke in the western part of Sweden |
| title_short | Prognostic value of acute National Institutes of Health Stroke Scale Items on disability: a registry study of first-ever stroke in the western part of Sweden |
| title_sort | prognostic value of acute national institutes of health stroke scale items on disability a registry study of first ever stroke in the western part of sweden |
| url | https://bmjopen.bmj.com/content/13/12/e080007.full |
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