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|Title:||Posterior National Institutes of Health Stroke Scale Improves Prognostic Accuracy in Posterior Circulation Stroke.||Austin Authors:||Alemseged, Fana;Rocco, Alessandro;Arba, Francesco;Schwabova, Jaroslava Paulasova;Wu, Teddy;Cavicchia, Leone;Ng, Felix C ;Ng, Jo Lyn;Zhao, Henry;Williams, Cameron;Sallustio, Fabrizio;Balabanski, Anna H;Tomek, Ales;Parson, Mark W;Mitchell, Peter J;Diomedi, Marina;Yassi, Nawaf;Churilov, Leonid ;Davis, Stephen M;Campbell, Bruce C V||Affiliation:||Neurology..
University of New South Wales, Department of Neurology, Liverpool Hospital, Ingham Institute for Applied Medical Research, Australia..
Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia..
School of Earth Sciences, University of Melbourne, Parkville, Australia..
Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia..
Liverpool Hospital and South West Sydney Clinical School, the University of New South Wales, Sydney, NSW, Australia..
NEUROFARBA Department, Careggi University Hospital, Florence, Italy..
Department of Neurology, Comprehensive Stroke Center, University Hospital Motol, Prague, Czech Republic..
Department of Neurology, Christchurch Hospital, New Zealand..
Stroke Unit, University Hospital of Tor Vergata, Rome, Italy..
Department of Radiology, Royal Melbourne Hospital, Parkville, Australia..
University of Melbourne, Parkville, Australia..
|Issue Date:||Apr-2022||Date:||2021-12-15||Publication information:||Stroke 2022; 53(4): 1247-1255||Abstract:||The National Institutes of Health Stroke Scale (NIHSS) underestimates clinical severity in posterior circulation stroke and patients presenting with low NIHSS may be considered ineligible for reperfusion therapies. This study aimed to develop a modified version of the NIHSS, the Posterior NIHSS (POST-NIHSS), to improve NIHSS prognostic accuracy for posterior circulation stroke patients with mild-moderate symptoms. Clinical data of consecutive posterior circulation stroke patients with mild-moderate symptoms (NIHSS <10), who were conservatively managed, were retrospectively analyzed from the Basilar Artery Treatment and Management registry. Clinical features were assessed within 24 hours of symptom onset; dysphagia was assessed by a speech therapist within 48 hours of symptom onset. Random forest classification algorithm and constrained optimization were used to develop the POST-NIHSS in the derivation cohort. The POST-NIHSS was then validated in a prospective cohort. Poor outcome was defined as modified Rankin Scale score ≥3 at 3 months. We included 202 patients (mean [SD] age 63  years, median NIHSS 3 [interquartile range, 1-5]) in the derivation cohort and 65 patients (mean [SD] age 63  years, median NIHSS 2 [interquartile range, 1-4]) in the validation cohort. In the derivation cohort, age, NIHSS, abnormal cough, dysphagia and gait/truncal ataxia were ranked as the most important predictors of functional outcome. POST-NIHSS was calculated by adding 5 points for abnormal cough, 4 points for dysphagia, and 3 points for gait/truncal ataxia to the baseline NIHSS. In receiver operating characteristic analysis adjusted for age, POST-NIHSS area under receiver operating characteristic curve was 0.80 (95% CI, 0.73-0.87) versus NIHSS area under receiver operating characteristic curve, 0.73 (95% CI, 0.64-0.83), P=0.03. In the validation cohort, POST-NIHSS area under receiver operating characteristic curve was 0.82 (95% CI, 0.69-0.94) versus NIHSS area under receiver operating characteristic curve 0.73 (95% CI, 0.58-0.87), P=0.04. POST-NIHSS showed higher prognostic accuracy than NIHSS and may be useful to identify posterior circulation stroke patients with NIHSS <10 at higher risk of poor outcome.||URI:||https://ahro.austin.org.au/austinjspui/handle/1/28363||DOI:||10.1161/STROKEAHA.120.034019||ORCID:||0000-0003-4001-1591
|Journal:||Stroke||PubMed URL:||34905944||PubMed URL:||https://pubmed.ncbi.nlm.nih.gov/34905944/||Type:||Journal Article||Subjects:||ataxia
|Appears in Collections:||Journal articles|
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