Validity of National Institutes of Health Stroke Scale for Severity of Stroke to Predict Mortality Among Patients Presenting With Symptoms of Stroke

Abstract

Introduction Cerebrovascular accident (CVA), also termed as stroke, is the third leading cause of mortality and the most common cause of disability globally. The National Institutes of Health Stroke Scale (NIHSS) is a valid assessment tool utilized to determine the severity of the stroke and can be used to prioritize patients to design treatment plans, rehabilitation, and better clinical outcomes. The primary objective of this study was to determine the validity of the NIHSS to predict mortality among patients presenting with symptoms of a stroke. Material and methods This was a descriptive case-series conducted over a period of six months between September 2019 and February 2020 at a tertiary care hospital in Nawabshah, Pakistan. The sample population included 141 patients admitted within 24 hours of the onset of symptoms of a stroke. A neurological examination of the patients was performed. On admission, stroke severity was evaluated with the NIHSS. After an initial clinical evaluation, patients underwent a non-enhanced computed tomography (CT) scan of the brain. The score of NIHSS and mortality at 72 hours were recorded on the pre-defined proforma by the investigators. All statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0 (Armonk, NY: IBM Corp). Results The mean age of the participants was 52.37±8.61 years. 68.1% of patients were hypertensive, 29.1% were diabetic, and 36.9% of patients were found with hyperlipidemia. The mortality rate was 41.1%. The mean NIHSS score was 16.68±6.72 points. The findings of this study demonstrated that the score of 14.9% cases was good (0-6 points), the score of 29.1% cases was moderate (7-15 points), and the score of 56% cases was poor (≥16 points). There was a significant association of NIHSS score with mortality (p<0.001).

Effectiveness of Melodic Intonation Therapy in Chinese Mandarin on Non-fluent Aphasia in Patients After Stroke: A Randomized Control Trial

“…Forty participants were recruited from CRRC, Beijing. The inclusion criteria were as follows: (1) diagnosed with fMRI or CT imaging, showing left ischemic stroke or hemorrhagic stroke; (2) The ninth language score on the National Institutes of Health Stroke Scale (NIHSS) (Farooque et al, 2020) is 1mild to moderate aphasia and 2-severe aphasia. (3) meeting the diagnostic criteria for non-fluent aphasia: less active speech expression, lack of fluency in speaking, acceptable hearing ability, can give a sign of yes/no questions, willing to express, good cooperation, and emotional stability (Wang et al, 2019); (4) Aphasia for more than 15 days after stroke, hospitalized patients; (4) aged 18-70; (5) tolerance to lying therapy for more than half an hour without postural hypotension; (6) The medication and other brain metabolism enhancers are the same; physical therapy, occupational therapy, and routine care are the same.…”

C-Reaction Protein and the Severity of Intracerebral Hemorrhage: A Study from Chinese Stroke Center Alliance

“…NIHSS (National Institutes of Health Stroke Scale) and GCS (Glasgow Coma Score) scores were also made by their professional neurologists after the ICH patients arrived at the hospital. A NIHSS score ≥15 or GCS ≤12 was defined as a severe stroke, and compared with the mild stroke group in our study [9,10].…”

The Connotation of Variances in the Risk Predictors, Medications, Homocysteine, and Homocysteine Pathway Gene Polymorphisms with CVA/Stroke

“…6,7 The number of stroke afflicted persons, in Pakistan, was around 80 of every 0.1 million individuals in year 2010, and number will greatly increase in the coming years. 4,5 The risk factors associated with stroke/CVA include conventionally assigned ones such as old age, male sex, hypercholesterolemia, hypertension, smoking, cardiovascular diseases, coagulopathies, as well as advanced "newly recognized" ones such as genetic polymorphisms, mRNA variants, elevated homocysteine, fibrinogen levels, and CRP among others. [8][9][10] There is strong predisposition of male gender, increasing age, higher blood pressure, smoking and less optimal physical activity with advanced odds of stroke.…”

“… 3 Stroke-related death was around five million in 2006 and is expected to rise by nearly another three million within 10 years. 4 The slight decline in CVAs detected in developed nations is concomitant with augmented cases in developing nations, however, the occurrence of disease, surviving patients, and even fatalities are continuously showing a rising trend. 5 In Pakistan, there are four million stroke cases, with the rate of CVA/stroke being five to 10 times higher as compared with United Kingdom or United States.…”

“… 6 7 The number of stroke afflicted persons, in Pakistan, was around 80 of every 0.1 million individuals in year 2010, and number will greatly increase in the coming years. 4 5 …”