The 24-hour NIH Stroke Scale as a Prognostic Tool for Basilar Artery Occlusion

Published on October 20, 2022

Imagine you’re a captain on a ship, navigating treacherous waters. The 24-hour National Institute of Health Stroke Scale (NIHSS) serves as your trusty compass, guiding you towards short- and long-term outcomes after endovascular treatment (EVT) for basilar artery occlusion (BAO). In this study, researchers evaluated the 24-hour NIHSS’s ability to predict favorable outcomes and mortality rates at 90 days and 1 year. They compared it to other measures like the NIHSS score at admission, NIHSS delta, and NIHSS percentage change. The results were clear – the 24-hour NIHSS reigned supreme as the best predictor of outcomes after EVT for BAO. With a threshold of ≤23 points, it served as a reliable surrogate in predicting both short- and long-term outcomes. So, if you find yourself battling against BAO, the 24-hour NIH Stroke Scale will be your steadfast navigator!

BackgroundThe present study aimed to evaluate the prognostic value of the 24-h National Institute of Health Stroke Scale (NIHSS) for short- and long-term outcomes of patients with basilar artery occlusion (BAO) after endovascular treatment (EVT) in daily clinical routine.MethodsPatients with EVT for acute basilar artery occlusion study registry with the 24-h NIHSS, and clinical outcomes documented at 90 days and 1 year were included. The NIHSS admission, 24-h NIHSS, NIHSS delta, and NIHSS percentage change, binary definitions of early neurological improvement [ENI; improvement of 4/(common ENI)/8 (major ENI)/10 (dramatic ENI)] NIHSS points were compared to predict the favorable outcomes and mortality at 90 days and 1 year. The primary outcome was defined as favorable if the modified Rankin Scale (mRS) score was 0–3 at 90 days.ResultsOf the 644 patients treated with EVT, the 24-h NIHSS had the highest discriminative ability for favorable outcome prediction [receiver operator characteristic (ROC)NIHSS 24 h area under the curve (AUC): 0.92 (0.90–0.94)] at 90 days and 1 year [(ROCNIHSS 24 h AUC: 0.91 (0.89–0.94)] in comparison to the NIHSS score at admission [ROCNIHSS admission AUC at 90 days: 0.73 (0.69–0.77); 1 year: 0.74 (0.70–0.78)], NIHSS delta [ROCΔ NIHSS AUC at 90 days: 0.84 (0.81–0.87); 1 year: 0.81 (0.77–0.84)], and NIHSS percentage change [ROC%change AUC at 90 days: 0.85 (0.82–0.89); 1 year: 0.82 (0.78–0.86)].ConclusionThe 24-h NIHSS with a threshold of ≤23 points was the best surrogate for short- and long-term outcomes after EVT for BAO in the clinical routine.

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