TY - JOUR
T1 - Predicting prognosis after stroke
T2 - A placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA stroke trial
AU - Frankel, Michael R.
AU - Morgenstern, L. B.
AU - Kwiatkowski, T.
AU - Lu, M.
AU - Tilley, B. C.
AU - Broderick, J. P.
AU - Libman, R.
AU - Levine, S. R.
AU - Brott, T.
PY - 2000/10/10
Y1 - 2000/10/10
N2 - 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.
AB - 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.
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U2 - 10.1212/WNL.55.7.952
DO - 10.1212/WNL.55.7.952
M3 - Article
C2 - 11061250
AN - SCOPUS:0034633789
SN - 0028-3878
VL - 55
SP - 952
EP - 959
JO - Neurology
JF - Neurology
IS - 7
ER -