美国国立卫生研究院卒中量表在预测自发性急性脑出血的预后方面与脑出血评分相当。
The National Institutes of Health Stroke Scale is comparable to the ICH score in predicting outcomes in spontaneous acute intracerebral hemorrhage.
作者信息
Kazaryan Suzie A, Shkirkova Kristina, Saver Jeffrey L, Liebeskind David S, Starkman Sidney, Bulic Sebina, Poblete Roy, Kim-Tenser May, Guo Shujing, Conwit Robin, Villablanca Pablo, Hamilton Scott, Sanossian Nerses
机构信息
Roxanna Todd Hodges Comprehensive Stroke Program, Department of Neurology, University of Southern California, Los Angeles, CA, United States.
Comprehensive Stroke Center and Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States.
出版信息
Front Neurol. 2024 Jul 1;15:1401793. doi: 10.3389/fneur.2024.1401793. eCollection 2024.
BACKGROUND
Validating the National Institutes of Health NIH Stroke Scale (NIHSS) as a tool to assess deficit severity and prognosis in patients with acute intracerebral hemorrhage would harmonize the assessment of intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) patients, enable clinical use of a readily implementable and non-imaging dependent prognostic tool, and improve monitoring of ICH care quality in administrative datasets.
METHODS
Among randomized trial ICH patients, the relation between NIHSS scores early after Emergency Department arrival and 3-month outcomes of dependency or death (modified Rankin Scale, mRS 3-6) and case fatality was examined. NIHSS predictive performance was compared to a current standard prognostic scale, the intracerebral hemorrhage score (ICH score).
RESULTS
Among the 384 patients, the mean age was 65 (±13), with 66% being male. The median NIHSS score was 16 (interquartile range (IQR) 9-25), the mean initial hematoma volume was 29 mL (±38), and the ICH score median was 1 (IQR 0-2). At 3 months, the mRS had a median of 4 (IQR 2-6), with dependency or death occurring in 70% and case fatality in 26%. The NIHSS and ICH scores were strongly correlated ( = 0.73), and each was strongly correlated with the 90-day mRS (NIHSS, = 0.61; ICH score, = 0.62). The NIHSS performed comparably to the ICH score in predicting both dependency or death ( = 0.80 vs. 0.80, = 0.83) and case fatality ( = 0.78 vs. 0.80, = 0.29). At threshold values, the NIHSS predicted dependency or death with 74.1% accuracy (NIHSS 17.5) and case fatality with 75.0% accuracy (NIHSS 18.5).
CONCLUSION
The NIHSS forecasts 3-month functional and case fatality outcomes with accuracy comparable to the ICH Score. Widely documented in routine clinical care and administrative data, the NIHSS can serve as a valuable measure for clinical prognostication, therapy development, and case-mix risk adjustment in ICH patients.Clinicaltrials.gov, NCT00059332.
背景
验证美国国立卫生研究院卒中量表（NIHSS）作为评估急性脑出血患者神经功能缺损严重程度和预后的工具，将使脑出血（ICH）和急性缺血性卒中（AIS）患者的评估趋于一致，能够在临床中使用易于实施且不依赖影像学的预后工具，并改善行政数据集中对ICH医疗质量的监测。
方法
在随机试验的ICH患者中，研究了急诊科就诊后早期NIHSS评分与3个月时依赖或死亡结局（改良Rankin量表，mRS 3 - 6）及病死率之间的关系。将NIHSS的预测性能与当前标准预后量表脑出血评分（ICH评分）进行比较。
结果
384例患者中，平均年龄为65岁（±13），男性占66%。NIHSS评分中位数为16（四分位间距（IQR）9 - 25），初始血肿平均体积为29 mL（±38），ICH评分中位数为1（IQR 0 - 2）。3个月时，mRS中位数为4（IQR 2 - 6），70%的患者出现依赖或死亡，26%的患者死亡。NIHSS评分与ICH评分高度相关（= 0.73），且二者均与90天mRS高度相关（NIHSS，= 0.61；ICH评分，= 0.62）。在预测依赖或死亡（= 0.80对0.80，= 0.83）及病死率（= 0.78对0.80，= 0.29）方面，NIHSS与ICH评分表现相当。在阈值时，NIHSS预测依赖或死亡的准确率为74.1%（NIHSS 17.5），预测病死率的准确率为75.0%（NIHSS 18.5）。
结论
NIHSS对3个月功能结局和病死率的预测准确性与ICH评分相当。NIHSS在常规临床护理和行政数据中有广泛记录，可作为ICH患者临床预后评估、治疗方案制定及病例组合风险调整的重要指标。Clinicaltrials.gov，NCT00059332。
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