Validation of the National Institutes of Health Stroke Scale in Intracerebral Hemorrhage
Background We sought to determine if the National Institutes of Health Stroke Scale (NIHSS) has a greater discriminative power than Glasgow coma scale (GCS) to identify patients at risk of poor early functional outcomes and large hematoma volumes. Methods We prospectively collected clinical assessme...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-07-01
|
| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.123.000834 |
| _version_ | 1797787476601864192 |
|---|---|
| author | Wendy Dusenbury Georgios Tsivgoulis Jason Chang Nitin Goyal Victoria Swatzell Andrei V. Alexandrov Patrick Lyden Anne W. Alexandrov |
| author_facet | Wendy Dusenbury Georgios Tsivgoulis Jason Chang Nitin Goyal Victoria Swatzell Andrei V. Alexandrov Patrick Lyden Anne W. Alexandrov |
| author_sort | Wendy Dusenbury |
| collection | DOAJ |
| description | Background We sought to determine if the National Institutes of Health Stroke Scale (NIHSS) has a greater discriminative power than Glasgow coma scale (GCS) to identify patients at risk of poor early functional outcomes and large hematoma volumes. Methods We prospectively collected clinical assessments, imaging, and outcome data in consecutive patients with intracerebral hemorrhage, and determined the ability of GCS and NIHSS to predict poor functional outcome (modified Rankin scale 3–6) and hematoma volume >30 cm3 using receiver operating characteristics analysis, C‐statistics, and the DeLong test. Results We studied 672 patients with intracerebral hemorrhage (mean age 62±14 years; 56% men; median intracerebral hemorrhage score=1, interquartile range (IQR) 0–2; median intracerebral hemorrhage volume 7 cm3, IQR 2–19) with median NIHSS of 8 (IQR 3–18) and GCS 15 (IQR 7–15). NIHSS correlated strongly to GCS (r=−0.773; P<0.001). Admission NIHSS (C‐statistic: 0.91; 95% CI, 0.89–0.93) predicted better than GCS (0.78; 95% CI, 0.75–0.81) discharge poor functional outcome (DeLong test P<0.001). NIHSS (0.82; 95% CI, 0.78–0.86) also discriminated better than GCS (0.78; 95% CI, 0.73–0.83) patients with large hematoma volume (DeLong test P=0.029). Conclusion The NIHSS has a greater discriminative power than GCS to identify patients at risk of poor early functional outcomes and large hematoma volumes. |
| first_indexed | 2024-03-13T01:22:23Z |
| format | Article |
| id | doaj.art-7c46661d535945f6b978753c758fd9ef |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-03-13T01:22:23Z |
| publishDate | 2023-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-7c46661d535945f6b978753c758fd9ef2023-07-04T18:29:17ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-07-013410.1161/SVIN.123.000834Validation of the National Institutes of Health Stroke Scale in Intracerebral HemorrhageWendy Dusenbury0Georgios Tsivgoulis1Jason Chang2Nitin Goyal3Victoria Swatzell4Andrei V. Alexandrov5Patrick Lyden6Anne W. Alexandrov7University of Tennessee Health Science Center Memphis TNUniversity of Tennessee Health Science Center Memphis TNWashington Hospital Center Washington DCUniversity of Tennessee Health Science Center Memphis TNUniversity of Tennessee Health Science Center Memphis TNUniversity of Tennessee Health Science Center Memphis TNZilkha Neurogenetic Institute at the Keck School of Medicine of USC Los Angeles CAUniversity of Tennessee Health Science Center Memphis TNBackground We sought to determine if the National Institutes of Health Stroke Scale (NIHSS) has a greater discriminative power than Glasgow coma scale (GCS) to identify patients at risk of poor early functional outcomes and large hematoma volumes. Methods We prospectively collected clinical assessments, imaging, and outcome data in consecutive patients with intracerebral hemorrhage, and determined the ability of GCS and NIHSS to predict poor functional outcome (modified Rankin scale 3–6) and hematoma volume >30 cm3 using receiver operating characteristics analysis, C‐statistics, and the DeLong test. Results We studied 672 patients with intracerebral hemorrhage (mean age 62±14 years; 56% men; median intracerebral hemorrhage score=1, interquartile range (IQR) 0–2; median intracerebral hemorrhage volume 7 cm3, IQR 2–19) with median NIHSS of 8 (IQR 3–18) and GCS 15 (IQR 7–15). NIHSS correlated strongly to GCS (r=−0.773; P<0.001). Admission NIHSS (C‐statistic: 0.91; 95% CI, 0.89–0.93) predicted better than GCS (0.78; 95% CI, 0.75–0.81) discharge poor functional outcome (DeLong test P<0.001). NIHSS (0.82; 95% CI, 0.78–0.86) also discriminated better than GCS (0.78; 95% CI, 0.73–0.83) patients with large hematoma volume (DeLong test P=0.029). Conclusion The NIHSS has a greater discriminative power than GCS to identify patients at risk of poor early functional outcomes and large hematoma volumes.https://www.ahajournals.org/doi/10.1161/SVIN.123.000834Glasgow coma scaleintracerebral hemorrhageNIH stroke scale |
| spellingShingle | Wendy Dusenbury Georgios Tsivgoulis Jason Chang Nitin Goyal Victoria Swatzell Andrei V. Alexandrov Patrick Lyden Anne W. Alexandrov Validation of the National Institutes of Health Stroke Scale in Intracerebral Hemorrhage Stroke: Vascular and Interventional Neurology Glasgow coma scale intracerebral hemorrhage NIH stroke scale |
| title | Validation of the National Institutes of Health Stroke Scale in Intracerebral Hemorrhage |
| title_full | Validation of the National Institutes of Health Stroke Scale in Intracerebral Hemorrhage |
| title_fullStr | Validation of the National Institutes of Health Stroke Scale in Intracerebral Hemorrhage |
| title_full_unstemmed | Validation of the National Institutes of Health Stroke Scale in Intracerebral Hemorrhage |
| title_short | Validation of the National Institutes of Health Stroke Scale in Intracerebral Hemorrhage |
| title_sort | validation of the national institutes of health stroke scale in intracerebral hemorrhage |
| topic | Glasgow coma scale intracerebral hemorrhage NIH stroke scale |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.123.000834 |
| work_keys_str_mv | AT wendydusenbury validationofthenationalinstitutesofhealthstrokescaleinintracerebralhemorrhage AT georgiostsivgoulis validationofthenationalinstitutesofhealthstrokescaleinintracerebralhemorrhage AT jasonchang validationofthenationalinstitutesofhealthstrokescaleinintracerebralhemorrhage AT nitingoyal validationofthenationalinstitutesofhealthstrokescaleinintracerebralhemorrhage AT victoriaswatzell validationofthenationalinstitutesofhealthstrokescaleinintracerebralhemorrhage AT andreivalexandrov validationofthenationalinstitutesofhealthstrokescaleinintracerebralhemorrhage AT patricklyden validationofthenationalinstitutesofhealthstrokescaleinintracerebralhemorrhage AT annewalexandrov validationofthenationalinstitutesofhealthstrokescaleinintracerebralhemorrhage |