Threshold for NIH stroke scale in predicting vessel occlusion and functional outcome after stroke thrombolysis
Threshold for NIH stroke scale in predicting vessel occlusion and functional outcome after stroke thrombolysis
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DOI：
10.1111/ijs.12451
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发表时间：
2015-08-01
影响因子：
6.7
通讯作者：
Ahmed, Niaz
中科院分区：
文献类型：
--
作者：
Cooray, Charith;Fekete, Klara;Ahmed, Niaz
在预测卒中溶栓治疗(静脉溶栓)后的预后方面，数据仅限于美国国立卫生研究院基线卒中评分的最佳阈值。目的寻找预测功能性结果和基线血管闭塞的基线美国国立卫生研究院卒中评分的阈值。方法：我们分析了在SITS-国际卒中溶栓登记中，44331名患者在3个月时具有可用的改良朗金评分，以及11632名计算机断层扫描/磁共振血管成像记录的基线血管闭塞患者。主要结果是3个月时的功能独立性(改良的Rankin评分0-2)和基线血管闭塞。结果对于功能独立性，美国国立卫生研究院卒中量表评分为12分(曲线下面积)，对于基线血管闭塞，11分(曲线下面积0678)为最佳阈值。对于功能独立性，调整后的优势比降至007(95%可信区间005-011)，对于存在基线闭塞，美国国立卫生研究院卒中量表评分12和11的AOR分别增加到328(95%可信区间304-358)，而国立卫生研究院卒中量表评分为0。美国国立卫生研究院卒中评定量表阈值从发病到成像的时间随着时间的推移而降低，如果成像时间超过3小时，则分别为2-3分。结论理想情况下，所有急性中风患者都应该立即获得多模式成像。事实上，这些服务是有限的。基线美国国立卫生研究院卒中量表评分11分和12分分别被确定为静脉溶栓治疗后基线血管闭塞和功能独立性的标志。这些值是时间相关的；因此，在院前选择立即转移到具有多模式成像和高度专门化治疗的中心的患者时，可以考虑使用9或10分的美国国立卫生研究院卒中评分阈值。
BackgroundData are limited on optimal threshold for baseline National Institutes of Health Stroke Scale in predicting outcome after stroke thrombolysis (intravenous thrombolysis).AimsFinding thresholds for baseline National Institutes of Health Stroke Scale scores that predict functional outcome and baseline vessel occlusion.MethodsWe analyzed 44331 patients with available modified Rankin Scale score at three-months and 11632 patients with computed tomography/magnetic resonance angiography documented vessel occlusion at baseline in the SITS-International Stroke Thrombolysis Register. Main outcomes were functional independency (modified Rankin Scale 0-2) at three-months and baseline vessel occlusion. We obtained area under the curves by receiver operating characteristic analysis and calculated multivariately adjusted odds ratio for the outcomes of interest based on baseline National Institutes of Health Stroke Scale scores.ResultsFor functional independency, National Institutes of Health Stroke Scale scores of 12 (area under the curve 0775) and for baseline vessel occlusion, scores of 11 (area under the curve 0678) were optimal threshold values. For functional independency, adjusted odds ratio decreased to 007 (95% CI 005-011), and for presence of baseline occlusion, aOR increased to 328 (95% CI 304-358) for National Institutes of Health Stroke Scale scores 12 and 11, respectively, compared with National Institutes of Health Stroke Scale score 0. National Institutes of Health Stroke Scale thresholds decreased with time from stroke onset to imaging, with 2-3 points, respectively, if time to imaging exceeded three-hours.ConclusionsIdeally, all acute stroke patients should have immediate access to multimodal imaging. In reality these services are limited. Baseline National Institutes of Health Stroke Scale scores of 11 and 12 were identified as markers of baseline vessel occlusion and functional independency after intravenous thrombolysis, respectively. These values are time dependent; therefore, a threshold of National Institutes of Health Stroke Scale 9 or 10 points may be considered in the prehospital selection of patients for immediate transfer to centers with multimodal imaging and availability of highly specialized treatments.