http://stroke.ahajournals.org/content/early/2015/09/10/STROKEAHA.115.010380.abstract
External Validation on Safe Implementation of Thrombolysis in Stroke–Monitoring Study Data
- Azmil H. Abdul-Rahim, MRCP, MBChB,
- Rachael L. Fulton, PhD,
- Heidi Sucharew, PhD,
- Dawn Kleindorfer, MD,
- Pooja Khatri, MD,
- Joseph P. Broderick, MD,
- Kennedy R. Lees, MD,
- for the SITS-MOST Steering Committee*
+ Author Affiliations
- Correspondence to Azmil H. Abdul-Rahim, MRCP, MBChB, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 44 Church St, Glasgow G11 6NT, United Kingdom. E-mail Azmil.Abdul-Rahim@glasgow.ac.uk
-
Guest Editor for this article was Markku Kaste, MD, PhD.
Abstract
Background and Purpose—National
Institutes of Health Stroke Scale (NIHSS) item profiles that were
recently proposed and validated may prove useful
for clinical prognostication and research
studies. We aimed to validate the NIHSS item profiles in hyper-acute
stroke patients
who received thrombolysis treatment
(tissue-type plasminogen activator).
Methods—We applied
the latent class analysis probabilities of the profile membership
generated from the derivation study onto NIHSS
data from the Safe Implementation of
Thrombolysis in Stroke–Monitoring Study (SITS-MOST). We separately
considered NIHSS data
collected within 3 hours and at ≈24 hours
after stroke onset to obtain 2 sets of symptom groupings. The
discrimination and
calibration of both sets of symptom profiles
were assessed from their association with outcomes. The outcome measures
included
modified Rankin Scale (mRS; using full
distribution and dichotomized, mRS 0–1 or back to baseline) at day 90
and mortality
by 90 days.
Results—We obtained
data for 6843 patients. Ordinal analysis of mRS showed odds of better
outcome across the profiles, for each set
of symptom profiles, adjusted for age, sex,
and prestroke mRS. Dichotomized outcomes mirrored the ordinal findings.
There
were significant differences in prognostic
discrimination ability for the dichotomized outcome measures between the
2 sets
of symptom profiles, with the latter set (ie,
24-hour symptom profiles) performing better.
Conclusions—The
NIHSS item profiles are individually associated with functional outcome
and mortality in acute stroke patients treated
with tissue-type plasminogen activator.
Considering profiles of NIHSS subscores rather than only the total score
is informative
for prognostication, particularly for
assessments collected 24 hours after stroke onset.
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