I would think that looking at MRI scans on a daily basis would provide a much more scientific basis for any predictions on recovery or death.
http://www.medpagetoday.com/Cardiology/Strokes/31308?utm_source=cardiodaily&utm_medium=email&utm_content=aha&utm_campaign=02-22-12&eun=gd3r&userid=424561&email=oc1dean@yahoo.com&mu_id=
The NIH stroke scale (NIHSS) score is a strong predictor of 30-day mortality among Medicare beneficiaries with acute ischemic stroke, even without other clinical information, researchers found.
In a model that included NIHSS score alone, there was "excellent" discrimination of mortality risk, especially when the score was used as a continuous variable (c-statistic 0.82), according to Gregg Fonarow, MD, of the University of California Los Angeles, and colleagues.
The score also yielded high discrimination when divided into four categories ranging from mild to extremely severe stroke (c-statistic 0.80), the researchers reported in the online Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease.
Adding demographic and clinical variables to the model only slightly increased the performance of the model (c-statistic 0.84).
"These findings suggest that it may be critical to collect and include stroke severity for optimal risk stratification and risk adjustment of 30-day mortality for Medicare beneficiaries with acute ischemic stroke," the authors wrote.
The NIHSS is well validated for assessing initial stroke severity, and the scores have been associated with mortality risk in acute ischemic stroke, although those studies have been subject to various limitations, including small sample sizes and single-center settings.
To overcome some of those weaknesses, Fonarow and colleagues examined data from 33,102 fee-for-service Medicare beneficiaries. They were treated for acute ischemic stroke at 404 hospitals participating in the Get With the Guidelines-Stroke (GWTG-Stroke) program from April 2003 through December 2006. The mean age of the patients was 79.
Patient data were linked with enrollment files and inpatient claims from the Centers for Medicare & Medicaid Services (CMS).
The median NIHSS score (5) fell in the mild stroke range. It was significantly higher in the 13.6% of patients who died at 30 days (17 versus 4, P<0.0001).
NIHSS score was related to 30-day mortality in a near-linear fashion, with death rates ranging from 2.3% for a score of zero to greater than 75% for a score of 40 or higher.
The 30-day mortality rates for patients based on NIHSS scores were:
- Mild stroke (0 to 7): 4.2%
- Moderate stroke (8 to 13): 13.9%
- Severe stroke (14 to 21): 31.6%
- Extremely severe stroke (22 to 42): 53.5%
Without contribution for any other factors, the NIHSS scores provided high discrimination of mortality risk as a continuous variable (c-statistic 0.82), when broken into four categories (c-statistic 0.80), and when broken into three categories (c-statistic 0.79).
The findings were similar regardless of age, sex, or prior history of stroke or transient ischemic attack.
The discrimination achieved with the NIHSS scores alone outperformed a model that included demographic and clinical variables without NIHSS (c-statistic 0.71).
According to Edward Jauch, MD, of the Medical University of South Carolina in Charleston, the "results reinforce the importance of using the NIHSS as a risk modifier in prognostic models used for stroke center certification, public reporting, and perhaps for pay-for-performance reimbursement in the future."
Current models used by CMS do not include the initial NIHSS score, which "may lead to unintentional financial disincentives in stroke centers which care for a disproportionate share of the most severe stroke patients," he wrote in an accompanying editorial. "Given the current modest payment rates for stroke, this may lead to the unintended consequence of decreasing access to stroke expertise in stroke systems of care."
Fonarow and colleagues pointed out some limitations of the study, including the applicability only to patients 65 and older in fee-for-service Medicare; the inclusion of hospitals participating in the GWTG-Stroke program only; the dependence on medical records for data; and the lack of information on the timing of NIHSS assessment, other metrics of stroke severity, and other clinical outcomes.
You can take the test scale here:http://www.ninds.nih.gov/doctors/NIH_Stroke_Scale.pdf
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