National Institutes of Health Stroke Scale Item Profiles as Predictor of Patient Outcome

Some century they are finally going to do predictions correctly when they finally realize that you need objective diagnosis of the dead and damaged areas of the brain. Like 3d PET and MRI scans. Almost everything in  NIHSS is subjective.
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

1. Azmil H. Abdul-Rahim, MRCP, MBChB,
2. Rachael L. Fulton, PhD,
3. Heidi Sucharew, PhD,
4. Dawn Kleindorfer, MD,
5. Pooja Khatri, MD,
6. Joseph P. Broderick, MD,
7. Kennedy R. Lees, MD,
8. for the SITS-MOST Steering Committee*

+ Author Affiliations

1. From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., R.L.F., K.R.L.); Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Centre, OH (H.S.); and Department of Neurology, University of Cincinnati College of Medicine, OH (D.K., P.K., J.P.B.).

1. 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

1. 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.