Quinn Terence J, Taylor-Rowan Martin, Coyte Aishah, Clark Allan B, Musgrave Stanley D, Metcalf Anthony K, Day Diana J, Bachmann Max O, Warburton Elizabeth A, Potter John F, Myint Phyo Kyaw
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
Front Neurol. 2017 Jun 13;8:275. doi: 10.3389/fneur.2017.00275. eCollection 2017.
The modified Rankin Scale (mRS) was designed to measure poststroke recovery but is often used to describe pre-stroke disability. We sought to evaluate three aspects of pre-stroke mRS: validity as a measure of pre-stroke disability; prognostic accuracy and association of pre-stroke mRS scores, and process of care.
We used data from a large, UK clinical registry. For analysis of validity, we compared pre-stroke mRS against other markers of pre-stroke function (age, comorbidity index, care needs). For analysis of prognostic accuracy, we described univariable and multivariable models comparing pre-stroke mRS and other prognostic variables against a variety of outcomes (early and late mortality, length of stay, institutionalization, incident complications). Finally, we described association of pre-stroke mRS and components of evidence-based stroke care (early neuroimaging, admission to stroke unit, assessment of swallow).
We analyzed data of 2,491 stroke patients. Concurrent validity analyses suggested statistically significant, but modest correlations between pre-stroke mRS and chosen variables (rho >0.40; < 0.0001 for all). Every point increase of pre-stroke mRS was associated with poorer outcomes for our prognostic variables (unadjusted < 0.001). This association held when corrected for other covariates. For example, pre-stroke mRS 4-5 odds ratio (OR): 6.84 (95% CI: 4.24-11.03) for 1 year mortality compared to mRS 0 in adjusted model. There was a difference between pre-stroke mRS and treatment, with higher pre-stroke mRS more likely to receive evidence-based care.
Results suggest that pre-stroke mRS has some concurrent validity and is a robust predictor of prognosis. This association is not explained by the influence of pre-stroke mRS on care pathways.
改良Rankin量表（mRS）旨在衡量卒中后的恢复情况，但常被用于描述卒中前的残疾程度。我们试图评估卒中前mRS的三个方面：作为卒中前残疾程度衡量指标的有效性；预后准确性以及卒中前mRS评分的相关性，还有医疗过程。
我们使用了来自英国一个大型临床登记处的数据。为了分析有效性，我们将卒中前mRS与卒中前功能的其他指标（年龄、合并症指数、护理需求）进行了比较。为了分析预后准确性，我们描述了单变量和多变量模型，将卒中前mRS和其他预后变量与各种结局（早期和晚期死亡率、住院时间、机构化、并发并发症）进行比较。最后，我们描述了卒中前mRS与循证卒中护理组成部分（早期神经影像学检查、入住卒中单元、吞咽评估）之间的相关性。
我们分析了2491例卒中患者的数据。同时效度分析表明，卒中前mRS与所选变量之间存在统计学上显著但适度的相关性（rho>0.40；所有P<0.0001）。卒中前mRS每增加1分，我们的预后变量结局就更差（未调整P<0.001）。在对其他协变量进行校正后，这种相关性依然存在。例如，在调整模型中，与mRS 0相比，卒中前mRS 4 - 5的1年死亡率比值比（OR）为6.84（95%CI：4.24 - 11.03）。卒中前mRS与治疗之间存在差异，卒中前mRS越高，接受循证护理的可能性越大。
结果表明，卒中前mRS具有一定的同时效度，并且是预后的有力预测指标。这种相关性不能用卒中前mRS对护理途径的影响来解释。
