National Institutes of Health Stroke Scale as an Outcome Measure for Acute Stroke Trials

HomeStrokeVol. 52, No. 1National Institutes of Health Stroke Scale as an Outcome Measure for Acute Trials Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBNational José-Miguel Yamal and James C. Grotta YamalJosé-Miguel Correspondence to: Yamal, PhD, Department Biostatistics Data Science, School Public at the University Texas Science Center Houston, 1200 Pressler, RAS E809, TX 77030. Email E-mail Address: [email protected] Houston (J.-M.Y.). Search more papers by this author GrottaJames Mobile Unit Research, Clinical Innovation Research Institute Memorial Hermann Hospital, (J.C.G.). Originally published15 Dec 2020https://doi.org/10.1161/STROKEAHA.120.032994Stroke. 2021;52:142–143This article is a commentary on followingEarly Neurological Change After Ischemic Is Associated With 90-Day OutcomeOther version(s) articleYou are viewing most recent version article. Previous versions: December 15, 2020: Ahead Print The National (NIHSS) has been used extensively in trials acute ischemic stroke. While designed assess severity stroke, previous studies have also shown strong association between NIHSS 24 hours,1 change baseline hours,2,3 commonly measure stroke outcome, modified Rankin Scale, 90 days.See related article, p 132In issue journal, Heitsch et al4 confirm these results large dataset, focusing raw score measurement within 6 hours onset hours. For clinical trials, use metric can be surrogate or supplementary especially assessing treatments. scale easy fast carry out, low rates missing data availability online training certification its execution assure good reproducibility. study conclusions appear robust due relatively sample sizes, corroboration multiple sets, level data, with confirmation using imputation data.Supporting accurate outcome given showing correlation known factors associated better worse such tPA (tissue-type plasminogen activator) treatment, age, glucose, blood pressure. It important note that effect thrombectomy could not assessed since patients were excluded from vessel occlusion cohort. Another interesting point, discussed authors international study, varied site perhaps indicating some variability across globe how managed their outcomes.Besides might current documents it demonstrate dramatically dynamic nature course improvement deterioration substantial proportion, first likely earlier observations started prehospital setting (eg, Units) will discover even fluctuation correlations suggested stronger 3- 24-hour versus 6- data. add growing amount evidence demonstrating changes (improvement deterioration) occur early course, particularly after so observation made, chance detecting change.There few limitations should highlighted.1 underrepresentation Black Hispanic limits understanding any disparities differences among groups, regarding rate recovery deterioration. African descent consists only 7% al’s2 population. This increased outcomes patients. mechanism was very strong. suggest TOAST (Trial ORG 10172 Treatment) classification etiology (P<0.0001) than (P=0.02). Baseline correlated various mechanisms—higher cardioembolic artery strokes lower others. Hence, unclear future GENISIS group (Genetics Early Instability Stroke) purpose find instrument help define genetic studies. Perhaps coupling other variables machine learning revealing.3 difference two ordinal (baseline NIHSS) necessarily ordinal. Here, would mostly affect those do much opportunity improve, Figure 1, thus limiting utility patients.4 least ability predict 90-day compared age NIHSS. However, combination leads accuracy. suggests alone may sufficient prognostic factor (data shared reviewers).In conclusion, al raises questions affected timing initial assessment. An investigation into based time assessment affects associations warranted.DisclosuresDr reports grant funding Genentech CSL Behring consulting Frazer, Ltd. These all outside submitted work. no conflicts.FootnotesThe opinions expressed editors American Heart Association.This manuscript sent Sean I. Savitz, Guest Editor, editorial decision final disposition.For Disclosures, see page 143.Correspondence jose-miguel.[email protected].tmc.eduReferences1. Rangaraju S, Frankel M, Jovin TG. Prognostic value neurological examination anterior circulation stroke: post hoc analysis randomized controlled trials.Interv Neurol. 2016; 4:120–129. doi: 10.1159/000443801CrossrefMedlineGoogle Scholar2. Saver JL, Altman H. Relationship neurologic deficit functional shifts strengthens during onset.Stroke. 2012; 43:1537–1541. 10.1161/STROKEAHA.111.636928LinkGoogle Scholar3. Agarwal Scher E, Lord A, Frontera J, Ishida K, Torres Rostanski Mistry Mac Grory B, Cutting al. Redefined shows treatment benefit alteplase over placebo.Stroke. 2020; 51:1226–1230. 10.1161/STROKEAHA.119.027476LinkGoogle Scholar4. L, Ibanez Carrera C, Binkley MM, Strbian D, Tatlisumak T, Bustamante Ribó Molina Dávalos AA, outcome.Stroke. 52:132–141. 10.1161/STROKEAHA.119.028687Google Scholar eLetters(0)eLetters relate recently published journal forum providing unpublished Comments reviewed appropriate tone language. peer-reviewed. Acceptable comments posted website only. indexed PubMed. longer 500 words online. References limited 10. Authors cited comment invited reply, appropriate.Comments feedback AHA/ASA Scientific Statements Guidelines directed Manuscript Oversight Committee via page.Sign In Submit Response Article Back top Next FiguresReferencesRelatedDetailsCited By Roushdy Mikhail N Abdelaziz S (2023) deficient presenting cortical deafness; skills remain backbone: case report, Egyptian Journal Neurology, Psychiatry Neurosurgery, 10.1186/s41983-023-00645-3, 59:1 Mirończuk Kapica-Topczewska Socha Soroczyńska Jamiołkowski Chorąży Czarnowska Mitrosz Kułakowska A Kochanowicz J Disturbed Ratios Essential Toxic Trace Elements Potential Biomarkers Stroke, Nutrients, 10.3390/nu15061434, 15:6, (1434) Reale G, Iacovelli Rabuffetti Manganotti P, Marinelli Sacco Furlanis Ajčević Zauli Moci Giovannini Crosetti Grazzini Castiglia Podestà Calabresi Ferrarin M Caliandro P Actigraphic Sensors Describe Severity Phase: Implementing Multi-Parametric Monitoring Unit, Medicine, 10.3390/jcm12031178, 12:3, (1178) Wang R, Ren Li Bai X, Guo W, Yang Wu Q Zhang W (2022) Efficacy evaluation Buyang Huanwu Decoction period: systematic review Frontiers Pharmacology, 10.3389/fphar.2022.975816, 13 Hao Z, Ge Z meta-analysis intravenous thrombolysis bridging therapy 10.1097/MD.0000000000030879, 101:39, (e30879), Online publication date: 30-Sep-2022. Feng He Y, Dong Long L exploratory descriptive cohort prognosis ischaemic mechanical thrombectomy, Contemporary Nurse, 10.1080/10376178.2022.2107038, 58:4, (264-275), 4-Jul-2022. Lay-Ekuakille Chiffi Celesti Rahman Singh Infrared Oxygenation Process Generated Robotic Verticalization Bedridden People, IEEE Journal, 10.1109/JSEN.2021.3068670, 21:13, (14426-14433) Related articlesEarly OutcomeLaura Heitsch, Stroke. 2021;52:132-141 January 2021Vol Issue 1 Advertisement InformationMetrics © 2020 Association, Inc.https://doi.org/10.1161/STROKEAHA.120.032994PMID: 33317412 publishedDecember Keywordsoutcome assessment, health careresearchstrokeEditorialsclinical trialPDF download SubjectsClinical StudiesIschemic