Predicting prognosis after stroke: A placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA stroke trial

Michael R. Frankel, L. B. Morgenstern, T. Kwiatkowski, M. Lu, B. C. Tilley, J. P. Broderick, R. Libman, S. R. Levine, T. Brott

Research output: Contribution to journalArticlepeer-review

195 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)952-959
Number of pages8
JournalNeurology
Volume55
Issue number7
DOIs
StatePublished - Oct 10 2000

ASJC Scopus subject areas

  • Clinical Neurology

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