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Modified Rankin Scale Disability Status at Day 4 Poststroke is an Informative Predictor of Long-Term Day 90 Outcome
Open accessPreprint — published as 10.1016/j.jstrokecerebrovasdis.2024.107902 · Paper page
Abstract
Background: Long-term disability after stroke is standardly assessed 3 months post-onset, using the modified Rankin Scale (mRS). The value of an early, day 4 mRS assessment for projecting the 3-month disability outcome has not been formally investigated. Methods: In this cohort of patients with acute cerebral ischemia and intracranial hemorrhage, we analyzed day 4 and day 90 mRS assessments in the NIH Field Administration of Stroke Therapy– Magnesium (FAST-MAG) Phase 3 trial. The performance of day 4 mRS, alone and as part of multivariate models, in predicting day 90 mRS was assessed using correlation coefficients, percent agreement, and the kappa statistics. Results: Among the 1573 acute cerebrovascular disease (ACVD) patients, 1206 (76.7%) had acute cerebral ischemia (ACI), while 367 (23.3%) had intracranial hemorrhage. Among all 1573 ACVD patients, day 4 mRS and day 90 mRS correlated strongly, Spearman’s rho=0.79, in unadjusted analysis with weighted kappa of 0.59. For dichotomized outcomes, simple carry-forward of the day 4 mRS performed fairly well in agreeing with day 90 mRS: mRS 0-1 (k=0.67), 85.4%; mRS 0-2 (k=0.59), 79.5%; fatal outcome, 88.3% (k=0.33). Correlations of 4d and 90d mRS were stronger for ACI than ICH patients, 0.76 vs 0.71. Conclusions: In this acute cerebrovascular disease patient cohort, assessment of global disability performed on day 4 is highly informative regarding long-term, 3-month mRS disability outcome, alone, and even more strongly in combination with baseline prognostic variables. The day 4 mRS is a useful measure for imputing the final patient disability outcome in clinical trials and quality improvement programs.
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Metadata
- Authors
- Taleb, S., Lee, J. J.-H., Asanad, S., Starkman, S., Hamilton, S., Conwit, R. A., Sanossian, N., & Saver, J. L.
- Affiliations
- Kaiser Permanente (US)
- University of California, Los Angeles (US)
- University of Maryland, Baltimore (US)
- Stanford University (US)
- National Institute of Neurological Disorders and Stroke (US)
- Keck Hospital of USC (US)
- Corresponding author
- Taleb, Shayandokht
- ORCID
- Venue
- Journal of Stroke and Cerebrovascular Diseases
- Publisher
- openRxiv
- Published
- 2023-07-01
- Volume
- 33
- Issue
- 11
- Pages
- 107902-107902
- ISSN
- 1052-3057 (ISSN-L)
- PMC
- PMC10327286
- OpenAlex
- W4401073876
- Cited by
- 3
- References
- 17
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 1
- FWCI
- 0.61
- Type
- journal article
- Language
- en
- Open access
- green
- dx.doi.org
- Locations
- Journal of Stroke and Cerebrovascular Diseases (publishedVersion)
- medRxiv (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke
- Topics
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Clinical Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Keywords
- modified Rankin Scale, stroke outcome prediction, acute cerebral ischemia, intracranial hemorrhage, acute cerebrovascular disease, FAST-MAG trial, prognostic factors
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