Department of Neurology, University of Utah, Salt Lake City, UT.
Department of Emergency Medicine, Washington University, St. Louis, MO.
Arch Phys Med Rehabil. 2022 May;103(5):964-969. doi: 10.1016/j.apmr.2021.10.023. Epub 2021 Nov 20.
To develop a simple and effective risk score for predicting which stroke patients will have persistent impairment of upper extremity motor function at 90 days.
Post hoc analysis of clinical trial patients hospitalized with acute ischemic stroke who were followed for 90 days to determine functional outcome.
Patient were hospitalized at facilities across the United States.
We created a harmonized cohort of individual patients (N=1653) from the NINDS tPA, ALIAS part 2, IMS-III, DEFUSE 3, and FAST-MAG trials. We split the cohort into balanced derivation and validation samples.
Not applicable.
The primary outcome was persistent arm impairment, defined as a National Institutes of Health Stroke Scale (NIHSS) arm domain score of 2 to 4 at 90 days in patients who had a 24-hour NIHSS arm score of 1 or more. We used least absolute shrinkage and selection operator regression to determine the elements of the persistent upper extremity impairment (PUPPI) index, which we validated as a predictive tool.
We included 1653 patients (827 derivation, 826 validation), of whom 803 (48.6%) had persistent arm impairment. The PUPPI index gives 1 point each for age 55 years or older and NIHSS values of worse arm (4), worse leg (>2), facial palsy (3), and total NIHSS (≥10). The optimal cutpoint for the PUPPI index was 3 or greater, at which the area under the curve was greater than 0.75 for the derivation and validation cohorts and when using NIHSS values from either 24 hours or in a subacute or discharge time window. Results were similar across different levels of stroke severity.
The PUPPI index uses readily available information to accurately predict persistent upper extremity motor impairment at 90 days poststroke. The PUPPI index can be administered in minutes and could be used as inclusion criterion in recovery-related clinical trials or, with additional development, as a prognostic tool for patients, caregivers, and clinicians.
开发一种简单有效的风险评分，以预测哪些卒中患者在 90 天时会出现上肢运动功能持续受损。
对急性缺血性卒中住院患者进行临床试验的事后分析，这些患者在 90 天内进行功能结局随访。
患者在美国各地的医疗机构住院。
我们从 NINDS tPA、ALIAS 第 2 部分、IMS-III、DEFUSE 3 和 FAST-MAG 试验中创建了一个个体患者的协调队列（N=1653）。我们将队列分为均衡的推导和验证样本。
不适用。
主要结局为上肢持续性受损，定义为 NIHSS 上肢评分 2 至 4 分，24 小时 NIHSS 上肢评分≥1 分的患者 90 天时。我们使用最小绝对收缩和选择算子回归来确定持续性上肢损伤（PUPPI）指数的元素，我们将其验证为预测工具。
我们纳入了 1653 名患者（827 例推导，826 例验证），其中 803 名（48.6%）患者上肢持续受损。PUPPI 指数对 55 岁或以上的年龄和 NIHSS 值（上肢 4 分、下肢>2 分、面瘫 3 分和总 NIHSS≥10 分）各计 1 分。PUPPI 指数的最佳截断值为 3 分或更高，在推导和验证队列中，曲线下面积大于 0.75，并且在使用 24 小时或亚急性或出院时间窗内的 NIHSS 值时也是如此。结果在不同的卒中严重程度水平上相似。
PUPPI 指数使用易于获得的信息来准确预测卒中后 90 天上肢运动功能的持续受损。PUPPI 指数可在数分钟内完成，可用于康复相关临床试验的纳入标准，或在进一步开发后，作为患者、护理人员和临床医生的预后工具。
