Abstract:
BACKGROUND:Physicians are often asked to predict outcome after acute stroke. Very little information is available that can reliably predict the likelihood of severe disability or death. OBJECTIVE:To develop a practical method for predicting a poor outcome after acute ischemic stroke. METHODS:Data from the placebo arms of Parts 1 and 2 of the National Institute of Neurological Disorders and Stroke rt-PA [recombinant tissue plasminogen activator] Stroke Trial were used to identify variables that could predict a poor outcome, defined as moderately severe disability, severe disability, or death (Modified Rankin Scale score >3) 3 months after stroke. RESULTS:Baseline variables that predicted poor outcome were the NIH Stroke Scale (NIHSS) >17 plus atrial fibrillation, yielding a positive predictive value (PPV) of 96% (95% CI, 88 to 100%). The best predictor at 24 hours was NIHSS >22, yielding a PPV of 98% (95% CI, 93 to 100%). The best predictor at 7 to 10 days was NIHSS >16, yielding a PPV of 92% (95% CI, 85 to 99%). CONCLUSIONS:Patients with a severe neurologic deficit after acute ischemic stroke, as measured by the NIHSS, have a poor prognosis. During the first week after acute ischemic stroke, it is possible to identify a subset of patients who are highly likely to have a poor outcome. These findings require confirmation in a separate study.
journal_name
Neurologyjournal_title
Neurologyauthors
Frankel MR,Morgenstern LB,Kwiatkowski T,Lu M,Tilley BC,Broderick JP,Libman R,Levine SR,Brott Tdoi
10.1212/wnl.55.7.952subject
Has Abstractpub_date
2000-10-10 00:00:00pages
952-9issue
7eissn
0028-3878issn
1526-632Xjournal_volume
55pub_type
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