Predicting 90-day modified Rankin Scale score with discharge information in acute ischaemic stroke patients following treatment

Abstract

ObjectivesTo understand variability in modified Rankin Scale scores from discharge to 90 days in acute ischaemic stroke patients following treatment, and examine prediction of 90-day modified Rankin Scale score by using discharge modified Rankin Scale and discharge disposition.Materials and methodsRetrospective analysis of acute ischaemic stroke patients following treatment was performed from January 2016 to March 2020. Data collection included demographic and clinical characteristics and outcomes data (modified Rankin Scale score at discharge, 30 days and 90 days and discharge disposition). Pearson’s χ2 test assessed statistical differences in distribution of modified Rankin Scale scores at discharge, 30 days and 90 days. The predictive power of discharge modified Rankin Scale score and disposition quantified the association with 90-day outcome.ResultsA total of 280 acute ischaemic stroke patients (65.4% aged ≥65 years, 47.1% female, 60.7% white) were included in the analysis. The modified Rankin Scale score significantly changed between 30 and 90 days from discharge (p<0.001) after remaining stable from discharge to 30 days (p=0.665). The positive and negative predictive values of an unfavourable long-term outcome for discharge modified Rankin Scale scores of 3–5 were 67.7% (95% CI 60.4% to 75.0%) and 82.0% (95% CI 75.1% to 88.8%), and for non-home discharge disposition were 72.4% (95% CI 64.5% to 80.2%) and 74.5% (95% CI 67.8% to 81.3%), respectively.ConclusionsDischarge modified Rankin Scale score and non-home discharge disposition are good individual predictors of 90-day modified Rankin Scale score for ischaemic stroke patients following treatment.

A differential of the left eye and right eye neurological pupil index is associated with discharge modified Rankin scores in neurologically injured patients

“…In a different cohort of ischemic stroke patients, the change in mRS between day 90 and 1 year ranged between 36 and 41% with a counterbalanced number of mRS improvements and declines [54]. For the same cohort of ischemic patients, a different study has shown that discharge mRS is a good predictor of 90-day mRS [49]. There are more cases and studies to report of course; but, it is fairly universally accepted that most patients remain at the same mRS value from one timepoint to the next [53] and thus values at discharge, although not definitive, should be treated as one critical and reliable indication of longterm outcomes.…”

“…According to Pérez and Tilley [47] it is "the most commonly used outcome measure" in stroke trial. It comprises 7 grades of severity ranging from zero (no symptoms) to five (severe disability) and six (death) and is often dichotomized as good versus poor outcome [48,49]. The fact that mRS administration does not require any specialized equipment or formal training results in a wide range of reported reliability, but is generally enhanced with training and multiple raters [50,51].…”

Trends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients

“… 19 , 20 , 21 Moreover, many patients discharged with an mRS score of 3 improve to an mRS of 1 to 2 by 90 days poststroke. 22 …”

Predictors of stroke favorable functional outcome in Guinea, results from the Conakry stroke registry

“…Second, the local context prevented extensive ancillary investigations or even the full stroke work-up to determine stroke etiology in most patients. Therefore, inflammatory markers, stroke subtypes, and eventual cardiac structural anomalies could not be included in the predictive model despite the described association between those factors and stroke functional outcomes 18 , 54 , 62 . Finally, despite the large cohort and the fact that the clinical characteristics of our population meet those of other cohorts in SSA, it is possible, even if unlikely, that our results correspond to a local snapshot and may be generalizable to other similar contexts in SSA.…”

“…Stroke was defined according to the WHO definition 56 . Stroke severity was graded with the NIHSS and stroke outcome was based on the modified Rankin Scale (mRS) 57 at hospital discharge 54 , 58 . Favorable stroke outcome was defined as mRS 0–2 59 .…”