Prognostic Value of the 24-Hour Neurological Examination in Anterior Circulation Ischemic Stroke: A post hoc Analysis of Two Randomized Controlled Stroke Trials
Open accessAbstract
Background: Early prognostication of long-term outcomes following ischemic stroke can facilitate medical decision-making. We hypothesized that the 24-hour National Institute of Health Stroke Scale (NIHSS) predicts 3-month clinical outcomes in anterior circulation stroke. Methods: Secondary analyses of the Interventional Management of Stroke 3 (IMS3) and intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke [National Institute of Neurological Diseases and Stroke (NINDS) IV tPA] trials were performed. In participants with documented 24-hour NIHSS and 3-month Modified Rankin Scale (mRS), the predictive power of the 24-hour NIHSS and 24-hour NIHSS improvement for 3-month outcomes [mRS 0-2 and Barthel Index (BI) ≥95] was assessed. Percentages of good outcome (mRS 0-2 or BI ≥95) at 3, 6, and 12 months and mean quality of life (EQ5D™) index at 3 months across 24-hour NIHSS quartiles were compared. Results: The majority of the study participants were included (IMS3 n = 587/656, NINDS IV tPA n = 619/624). The 24-hour NIHSS was correlated with 3-month mRS (R = 0.73) with excellent predictive power for mRS 0-2 [area under the curve (AUC) = 0.91] and BI ≥95 (AUC = 0.9) in both cohorts. A model with the 24-hour NIHSS alone correctly classified 82-84% of patients in both cohorts. The percentages of good outcomes at 3-12 months across 24-hour NIHSS quartiles were similar in both cohorts. mRS 0-2 was achieved by 75.6-77.7% of patients with 24-hour NIHSS ≤11 but by only 1.4-3.6% with 24-hour NIHSS ≥20. The EQ5D index at 3 months varied among NIHSS 0-4 (mean 0.86 ± 0.16), 5-11 (0.77 ± 0.18), and 12-19 (0.59 ± 0.26) quartiles. Conclusions: The 24-hour NIHSS strongly predicts long-term stroke outcomes and is associated with quality of life. Its easy availability, reliability, and validity support its use as an early prognostic marker and surrogate of clinical outcome in ischemic stroke.
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NIHSS measured 24 hours after stroke onset is a strong predictor of functional outcome at 90 days.
“NIH stroke scale (NIHSS) measured 24 hours after stroke onset is a strong predictor of functional outcome at 90 days.”
From Early Neurological Change After Ischemic Stroke Is Associated With 90-Day Outcome (2021) · cites this paper as [1]
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The early outcome of thrombolytic treatment in ischaemic stroke patients: a retrospective analysis
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Advancements and Challenges in Hyperacute Stroke Translational Research
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Mechanical thrombectomy in ischemic stroke: Parameters affecting the TICI outcome
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Effect of COMT Val158Met Polymorphism on Stroke Functional Outcome and Recovery
Liang, J., Xu, M., Wang, X., Li, H., Luo, X., Christoforou, A., & Wang, Q. M. (2025) · Neurorehabilitation and neural repair · doi:10.1177/15459683251340926
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- Authors
- Rangaraju, S., Frankel, M., & Jovin, T. G.
- Affiliations
- Emory University (US)
- University of Pittsburgh Medical Center (US)
- Venue
- Interventional Neurology
- Publisher
- S. Karger AG
- Published
- 2015
- Volume
- 4
- Issue
- 3-4
- Pages
- 120-129
- ISSN
- 1664-5545 (ISSN-L)
- 1664-9737
- PMC
- PMC4817381
- OpenAlex
- W2300015032
- Semantic Scholar
- f0590f7306d98236961e64eb011ad3b4085b35e5
- Cited by
- 69
- References
- 26
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 6 · 2023: 7 · 2022: 8 · 2021: 11 · 2020: 11 · 2019: 6 · 2018: 5 · 2017: 4 · 2016: 2
- FWCI
- 2.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Interventional Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Brain Foundation
- Atlanta Clinical and Translational Science Institute
- National Institutes of Health (T32 grant, UL1TR000454)
- National Institute of Neurological Disorders and Stroke (U10NS086607, T32NS007480)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Keywords
- anterior circulation stroke, NIHSS, prognostic score, functional outcome prediction, modified Rankin Scale, Barthel Index, quality of life, EQ-5D, intravenous thrombolysis, stroke prognosis, neurological examination
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