Miyamoto Nobukazu, Tanaka Ryota, Ueno Yuji, Watanabe Masao, Kurita Naohide, Hira Kenichiro, Shimada Yoshiaki, Kuroki Takuma, Yamashiro Kazuo, Urabe Takao, Hattori Nobutaka
Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology, Juntendo Urayasu Hospital, Chiba, Japan.
Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2017 Dec;26(12):2834-2839. doi: 10.1016/j.jstrokecerebrovasdis.2017.07.005. Epub 2017 Aug 4.
Early neurological worsening is associated with increased mortality and long-term functional disability. We developed the WORSEN score for predicting whether patients with stroke will deteriorate during the week after stroke onset and investigated its usefulness.
We retrospectively investigated the cases of 478 patients who were admitted to Juntendo University Hospital between April 2007 and March 2009. Neurological deterioration was defined as a worsening of 4 points or higher on the National Institute of Health Stroke Scale score within 1 week of admission. Based on a previous study, we developed the WORSEN score, which was derived from the following factors: wrong (poor) blood sugar control (W), old myocardial infarction (O), radiological findings (R), infarct size (S), elevated low-density lipoprotein cholesterol (E), and neurological findings (N). Next, we investigated the utility of this scoring system in 456 other patients who were admitted to Juntendo University Hospital and Juntendo Urayasu Hospital between October 2013 and December 2014.
First, we checked the utility of the WORSEN score for detecting worsening in cases of stroke. In the first patient group, deterioration was noted in 32.5% of the patients with scores higher than 3 points (sensitivity: .704 and specificity: .744). For checking reproductivity on using the second group, deterioration was detected in 36.1% of the patients with WORSEN scores higher than 3 points (sensitivity: .740 and specificity: .835).
Careful attention should be paid to patients with acute stroke with high WORSEN scores. The WORSEN score might become a valuable tool for detecting the neurological deterioration of ischemic stroke.
早期神经功能恶化与死亡率增加及长期功能残疾相关。我们开发了WORSEN评分，用于预测卒中患者在卒中发作后一周内是否会恶化，并研究了其有效性。
我们回顾性调查了2007年4月至2009年3月间入住顺天堂大学医院的478例患者的病例。神经功能恶化定义为入院1周内美国国立卫生研究院卒中量表评分恶化4分或更高。基于先前的一项研究，我们开发了WORSEN评分，其源自以下因素：血糖控制不佳（W）、陈旧性心肌梗死（O）、影像学检查结果（R）、梗死面积（S）、低密度脂蛋白胆固醇升高（E）和神经学检查结果（N）。接下来，我们在2013年10月至2014年12月间入住顺天堂大学医院和顺天堂浦安医院的另外456例患者中研究了该评分系统的效用。
首先，我们检查了WORSEN评分在检测卒中病例恶化方面的效用。在第一组患者中，评分高于3分的患者中有32.5%出现恶化（敏感性：.704，特异性：.744）。为检验在第二组中的可重复性，WORSEN评分高于3分的患者中有36.1%被检测出恶化（敏感性：.740，特异性：.835）。
对于WORSEN评分高的急性卒中患者应予以密切关注。WORSEN评分可能成为检测缺血性卒中神经功能恶化的有价值工具。
