Baseline NIH Stroke Scale score strongly predicts outcome after stroke - A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)
Baseline NIH Stroke Scale score strongly predicts outcome after stroke - A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)
复制标题
DOI：
10.1212/wnl.53.1.126
复制
发表时间：
1999-07-13
期刊：
影响因子：
9.9
通讯作者：
Hansen, MD
中科院分区：
文献类型：
--
作者：
Adams, HP;Davis, PH;Hansen, MD
目的：比较基线美国国立卫生研究院卒中量表 (NIHSS) 评分和 Org 10172 急性卒中治疗 (TOAST) 卒中亚型试验作为缺血性卒中后 7 天和 3 个月结果的预测因子。方法：使用从参加临床试验的 1,281 名患者收集的数据，使用 TOAST 分类对中风亚型进行分类，并使用 NIHSS 量化基线神经功能损伤。使用巴塞尔指数 (BI) 和格拉斯哥结果量表 (GOS) 评估第 7 天和第 3 个月的结果。如果 GOS 评分为 1 并且 BI 为 19 或 20（范围为 0 到 20），则结果被评为优秀。根据年龄、性别、种族和既往中风史对分析进行了调整。结果：基线 NIHSS 评分强烈预测结果，NIHSS 上多加一分，7 天时获得优异结果的可能性就会降低 24%，3 个月时获得优异结果的可能性会降低 17%。 3 个月时，46% 的 NIHSS 评分为 7 至 10 分的患者和 23% 的 NIHSS 评分为 11 至 15 分的患者取得了优异的结果。经过多变量调整后，3 个月时腔隙性卒中的比值比为 3.1（95% Cl，1.5 至 6.4）。结论：NIHSS 评分可以有力地预测患者中风后康复的可能性。分数大于或等于 16 则预测死亡或严重残疾的可能性较高，而分数小于或等于 6 则预测恢复良好。只有腔隙性卒中的 TOAST 亚型可以独立于 NIHSS 评分来预测结果。
Objective: To compare the baseline National Institutes of Health Stroke Scale (NIHSS) score and the Trial of Org 10172 in Acute Stroke Treatment (TOAST) stroke subtype as predictors of outcomes at 7 days and 3 months after ischemic stroke. Methods: Using data collected from 1,281 patients enrolled in a clinical trial, subtype of stroke was categorized using the TOAST classification, and neurologic impairment at baseline was quantified using the NIHSS. Outcomes were assessed at 7 days and 3 months using the Barthel Index (BI) and the Glasgow Outcome Scale (GOS). An outcome was rated as excellent if the GOS score was 1 and the BI was 19 or 20 (scale of 0 to 20). Analyses were adjusted for age, sex, race, and history of previous stroke. Results: The baseline NIHSS score strongly predicted outcome, with one additional point on the NIHSS decreasing the likelihood of excellent outcomes at 7 days by 24% and at 3 months by 17%. At 3 months, excellent outcomes were noted in 46% of patients with NIHSS scores of 7 to 10 and in 23% of patients with scores of 11 to 15. After multivariate adjustment, lacunar stroke had an odds ratio of 3,1 (95% Cl, 1.5 to 6.4) for an excellent outcome at 3 months. Conclusions: The NIHSS score strongly predicts the likelihood of a patient's recovery after stroke. A score of greater than or equal to 16 forecasts a high probability of death or severe disability whereas a score of less than or equal to 6 forecasts a good recovery. Only the TOAST subtype of lacunar stroke predicts outcomes independent of the NIHSS score.