Darehed David, Reinholdsson Malin, Viktorisson Adam, Abzhandadze Tamar, Sunnerhagen Katharina S
Department of Public Health and Clinical Medicine (DD), Sunderby Research Unit, Umeå University; Rehabilitation Medicine Research Group (DD, MR, AV, TA, KSS), Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, and Sahlgrenska University Hospital; Department of Occupational Therapy and Physiotherapy (MR, TA); and Rehabilitation Medicine (KSS), Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden.
Neurol Clin Pract. 2023 Oct;13(5):e200186. doi: 10.1212/CPJ.0000000000200186. Epub 2023 Sep 1.
Of all strokes, mild strokes (defined as 5 points or less on the National Institutes of Health Stroke Scale [NIHSS]) are in the majority. However, up to one-third of patients with mild strokes still exhibit significant deficits 3 months after the stroke. Studies on the presumably mildest strokes, defined by zero points on the NIHSS (0-NIHSS) at admission, are scarce. Hence, we aimed to study patient characteristics and outcomes among patients with 0-NIHSS strokes.
Our retrospective registry-based study included a total of 6,491 adult patients with stroke admitted to 3 different stroke units in Gothenburg, Sweden, from November 2014 to June 2019. Our main outcome was a composite measure including death and activities of daily living (ADL) dependency 3 months after the stroke. Analyses of patient characteristics were followed by adjusted analyses including multiple confounders.
In total, 5,945 patients had data on NIHSS at admission, of whom 1,412 (24%) presented with a 0-NIHSS stroke. Among these, the median age was 72 years, 600 (42%) were female, and 86 (6%) had a hemorrhagic stroke. Among previously ADL-independent patients, 65 (6%) were either dead or ADL-dependent 3 months after the stroke. Prestroke physical inactivity (OR 2.48, 95% CI 1.40-4.38) and age (OR 1.05 per gained year, 95% CI 1.02-1.08) significantly increased the risk of death and ADL dependency.
One of 17 patients has either died or become ADL-dependent 3 months after a 0-NIHSS stroke, stressing that these strokes are not always benign. Older and physically inactive patients are at greater risk of an adverse outcome.
在所有中风患者中，轻度中风（定义为美国国立卫生研究院卒中量表[NIHSS]评分5分及以下）占大多数。然而，高达三分之一的轻度中风患者在中风后3个月仍表现出明显的功能缺陷。关于入院时NIHSS评分为零分（0-NIHSS）的可能最轻微中风的研究很少。因此，我们旨在研究0-NIHSS中风患者的特征和预后。
我们基于登记处的回顾性研究纳入了2014年11月至2019年6月期间在瑞典哥德堡3个不同中风单元住院的6491例成年中风患者。我们的主要结局是一个综合指标，包括中风后3个月的死亡和日常生活活动（ADL）依赖情况。在分析患者特征之后进行了包括多个混杂因素的校正分析。
总共有5945例患者入院时有NIHSS数据，其中1412例（24%）为0-NIHSS中风。在这些患者中，中位年龄为72岁，600例（42%）为女性，86例（6%）为出血性中风。在中风前ADL独立患者中，65例（6%）在中风后3个月死亡或出现ADL依赖。中风前身体不活动（比值比2.48，95%置信区间1.40-4.38）和年龄（每增加一岁比值比1.05，95%置信区间1.02-1.08）显著增加死亡和ADL依赖风险。
17例0-NIHSS中风患者中有1例在中风后3个月死亡或出现ADL依赖，这突出表明这些中风并非总是良性的。年龄较大和身体不活动的患者出现不良结局的风险更高。
