Predicting Prognosis After Stroke: A Placebo Group Analysis From the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial

Neurology. 2000 Oct 10;55(7):952-9. doi: 10.1212/wnl.55.7.952.

Abstract

Background: Physicians are often asked to predict outcome after acute stroke. Very little information is available that can reliably predict the likelihood of severe disability or death.

Objective: To develop a practical method for predicting a poor outcome after acute ischemic stroke.

Methods: Data from the placebo arms of Parts 1 and 2 of the National Institute of Neurological Disorders and Stroke rt-PA [recombinant tissue plasminogen activator] Stroke Trial were used to identify variables that could predict a poor outcome, defined as moderately severe disability, severe disability, or death (Modified Rankin Scale score >3) 3 months after stroke.

Results: Baseline variables that predicted poor outcome were the NIH Stroke Scale (NIHSS) >17 plus atrial fibrillation, yielding a positive predictive value (PPV) of 96% (95% CI, 88 to 100%). The best predictor at 24 hours was NIHSS >22, yielding a PPV of 98% (95% CI, 93 to 100%). The best predictor at 7 to 10 days was NIHSS >16, yielding a PPV of 92% (95% CI, 85 to 99%).

Conclusions: Patients with a severe neurologic deficit after acute ischemic stroke, as measured by the NIHSS, have a poor prognosis. During the first week after acute ischemic stroke, it is possible to identify a subset of patients who are highly likely to have a poor outcome. These findings require confirmation in a separate study.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Female
  • Humans
  • Male
  • Models, Neurological
  • Placebos
  • Predictive Value of Tests
  • Prognosis
  • Sensitivity and Specificity
  • Stroke / physiopathology*

Substances

  • Placebos