Stroke: a new quantitative score that can more effectively predict posterior circulation ischemia

One in five ischemic strokes affects the posterior circulation
.

The National Institutes of Health Stroke Scale (NIHSS) is a widely used scoring system to assess neurological deficits in acute stroke patients, it is an indispensable tool in treatment decisions and stroke research, and is closely related to post-stroke outcomes related

stroke

However, the NIHSS places great emphasis on impairments caused by lesions of the anterior circulation (eg, motor function and cortical landmarks, especially language)
.

Clinical features of posterior circulation stroke, such as gait/paraplegia, vertical gaze palsy, nystagmus, and bulbar signs, were not measured, so patients with posterior circulation stroke tended to have lower NIHSS scores than patients with anterior circulation stroke

Compared with patients with anterior circulation stroke, patients with posterior circulation stroke had lower NIHSS scores, suggesting that the NIHSS underestimated the clinical severity of posterior circulation stroke
.

However, patients with posterior circulation stroke were 23% more likely to have low NIHSS at 3 months than patients with anterior circulation stroke

Previous studies reported that >75% of patients with posterior circulation stroke had a baseline NIHSS score of 0 to 5
.

In patients with mild clinical impairment, the benefit of reperfusion therapy is less certain

In patients with mild clinical impairment, the benefit of reperfusion therapy is less certain

Vascular management

However, endovascular thrombectomy is beneficial in patients with an NIHSS score ≥10
.

These results may make patients with NIHSS scores <10 less likely to receive endovascular therapy

thrombus

Hereby, Fana Alemseged et al.
, University of Melbourne, assessed the prognostic value of additional clinical features in conservatively treated patients with posterior circulation stroke and mild-to-moderate symptoms (NIHSS score <10), and used this information to derive and validate NIHSS A modified version, ie Post-NIHSS (POST-NIHSS)
.

Clinical data from consecutive posterior circulation stroke patients with mild to moderate symptoms (NIHSS < 10) who received conservative management 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 speech therapist within 48 hours of symptom onset

In a derived cohort, POST-NIHSS is developed using the random forest classification algorithm and constrained optimization
.

Then, POST-NIHSS was validated in a prospective cohort

We included 202 patients (mean [SD] age 63 [14] years, NIHSS median 3 [interquartile range, 1-5]) in the derived cohort and 65 patients in the validation cohort ( Mean [SD] age 63 [16] years, NIHSS median 2 [interquartile range, 1-4])
.

In the derived cohort, age, NIHSS, abnormal cough, dysphagia, and gait/striated ataxia were listed 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/striated ataxia to the baseline NIHSS
.

In the age-adjusted ROC characteristic analysis, the area under the POST-NIHSS receiver operating characteristic curve was 0.
80 (95% CI, 0.
73-0.
87), while the area under the NIHSS receiver operating characteristic curve was 0.
73 (95% CI, 0.
73).
0.
64-0.
83), P=0.
03
.

In the validation cohort, the area under the POST-NIHSS receiver operating characteristic curve was 0.
82 (95% CI, 0.
69-0.
94), while the area under the NIHSS receiver operating characteristic curve was 0.
73 (95% CI, 0.
58-0.
87), P=0.
04
.

The area under the POST-NIHSS receiver operating characteristic curve is 0.
82

The significance of this study lies in its findings: POST-NIHSS shows higher prognostic accuracy than NIHSS and may help identify posterior circulation stroke patients with NIHSS <10 who are at higher prognostic risk
.

POST-NIHSS shows higher prognostic accuracy than NIHSS

Original source:
[Alemseged F, Rocco A, Arba F, et al.
Posterior National Institutes of Health Stroke Scale Improves Prognostic Accuracy in Posterior Circulation Stroke.
Stroke.
Published online December 15, 2021:STROKEAHA.
120.
034019.
doi:10.
1161/STROKEAHA.
120.
034019] (https://doi.
org/10.
1161/STROKEAHA.
120.
034019)

Posterior National Institutes of Health Stroke Scale Improves Prognostic Accuracy in Posterior Circulation Stroke.

 

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