Deans' stroke musings: Development of a prediction model for poor outcomes after thrombolysis in mild non-disabling ischemic stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, January 27, 2026

Development of a prediction model for poor outcomes after thrombolysis in mild non-disabling ischemic stroke

Where is your scientific proof that ANY PREDICTION MODEL gets survivors recovered? NONE? I thought so! So, you're incompetently DOING NOTHING to help survivors? You'd be fired immediately in any business setting! Even proposing crapola like this should get you fired!

Development of a prediction model for poor outcomes after thrombolysis in mild non-disabling ischemic stroke

Xiaopan Cao¹

Zhijian Fu¹

Li Li²

Li Ren¹

Yang Jiang³^*

Xue Cong⁴

Bing Xu⁵^*

Xin Zhang⁶

¹Department of Neurology VIII, Shenyang First People’s Hospital, Shenyang, Liaoning, China
²Department of Neurology I, Shenyang First People’s Hospital, Shenyang, Liaoning, China
³Neurology Outpatient Department, Shenyang First People’s Hospital, Shenyang, Liaoning, China
⁴Department of Critical Care Medicine, Shenyang First People’s Hospital, Shenyang, Liaoning, China
⁵Department of Neurology, Shenyang Tenth People’s Hospital, Shenyang, Liaoning, China
⁶Department of Neurorehabilitation, Shenyang First People’s Hospital, Shenyang, Liaoning, China

Background: Mild non-disabling ischemic stroke (MNDIS) is increasingly treated with intravenous thrombolysis, yet a substantial proportion of patients still experience poor functional outcomes, and robust tools for individualized risk prediction are lacking.

Methods: In this retrospective cohort study, we analyzed 713 consecutive MNDIS patients who received intravenous thrombolysis within 4.5 h of symptom onset at an advanced stroke center between January 1, 2022 and December 31, 2024. Poor outcome was defined as a 90-day modified Rankin Scale (mRS) score ≥2. Candidate predictors, including demographic, clinical, laboratory, hemodynamic and imaging variables, were first screened by univariable analysis and then entered into a stepwise multivariable logistic regression model (entry p < 0.05, removal p > 0.10). A nomogram incorporating independent predictors was constructed in R, and its performance was evaluated using receiver operating characteristic (ROC) analysis, bootstrap calibration, and decision curve analysis.

Results: Of the 713 patients, 91 (12.8%) had poor 90-day outcomes (mRS 2–6) and 622 (87.2%) had good outcomes (mRS 0–1). Admission NIHSS score (OR 1.37; 95% CI 1.10–1.72), 24-h NIHSS score (OR 1.78; 95% CI 1.52–2.10), diastolic blood pressure (OR 1.02 per mmHg; 95% CI 1.00–1.05), and coronary heart disease (OR 1.88; 95% CI 1.05–3.35) were independently associated with poor outcome. The resulting nomogram showed good discrimination (AUC 0.835; 95% CI 0.805–0.861; sensitivity 71.4%; specificity 84.1%), excellent calibration (bootstrap mean absolute error 0.014), and provided positive net clinical benefit across a wide range of risk thresholds (0.03–0.89).

Conclusion: Admission and 24-h NIHSS scores, diastolic blood pressure, and coronary heart disease are key predictors of poor 90-day outcomes after thrombolysis in patients with MNDIS. The derived nomogram offers accurate, well-calibrated, and clinically useful individualized risk estimation, and may assist clinicians in early post-thrombolysis risk stratification and tailoring the intensity of monitoring and follow-up.