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Relationship of national institutes of health stroke scale to 30-day mortality in medicare beneficiaries with acute ischemic stroke.

Publication ,  Journal Article
Fonarow, GC; Saver, JL; Smith, EE; Broderick, JP; Kleindorfer, DO; Sacco, RL; Pan, W; Olson, DM; Hernandez, AF; Peterson, ED; Schwamm, LH
Published in: J Am Heart Assoc
February 2012

BACKGROUND: The National Institutes of Health Stroke Scale (NIHSS), a well-validated tool for assessing initial stroke severity, has previously been shown to be associated with mortality in acute ischemic stroke. However, the relationship, optimal categorization, and risk discrimination with the NIHSS for predicting 30-day mortality among Medicare beneficiaries with acute ischemic stroke has not been well studied. METHODS AND RESULTS: We analyzed data from 33102 fee-for-service Medicare beneficiaries treated at 404 Get With The Guidelines-Stroke hospitals between April 2003 and December 2006 with NIHSS documented. The 30-day mortality rate by NIHSS as a continuous variable and by risk-tree determined or prespecified categories were analyzed, with discrimination of risk quantified by the c-statistic. In this cohort, mean age was 79.0 years and 58% were female. The median NIHSS score was 5 (25th to 75th percentile 2 to 12). There were 4496 deaths in the first 30 days (13.6%). There was a strong graded relation between increasing NIHSS score and higher 30-day mortality. The 30-day mortality rates for acute ischemic stroke by NIHSS categories were as follows: 0 to 7, 4.2%; 8 to 13, 13.9%; 14 to 21, 31.6%; 22 to 42, 53.5%. A model with NIHSS alone provided excellent discrimination whether included as a continuous variable (c-statistic 0.82 [0.81 to 0.83]), 4 categories (c-statistic 0.80 [0.79 to 0.80]), or 3 categories (c-statistic 0.79 [0.78 to 0.79]). CONCLUSIONS: The NIHSS provides substantial prognostic information regarding 30-day mortality risk in Medicare beneficiaries with acute ischemic stroke. This index of stroke severity is a very strong discriminator of mortality risk, even in the absence of other clinical information, whether used as a continuous or categorical risk determinant. (J Am Heart Assoc. 2012;1:42-50.).

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

February 2012

Volume

1

Issue

1

Start / End Page

42 / 50

Location

England

Related Subject Headings

  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

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APA
Chicago
ICMJE
MLA
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Fonarow, G. C., Saver, J. L., Smith, E. E., Broderick, J. P., Kleindorfer, D. O., Sacco, R. L., … Schwamm, L. H. (2012). Relationship of national institutes of health stroke scale to 30-day mortality in medicare beneficiaries with acute ischemic stroke. J Am Heart Assoc, 1(1), 42–50. https://doi.org/10.1161/JAHA.111.000034
Fonarow, Gregg C., Jeffrey L. Saver, Eric E. Smith, Joseph P. Broderick, Dawn O. Kleindorfer, Ralph L. Sacco, Wenqin Pan, et al. “Relationship of national institutes of health stroke scale to 30-day mortality in medicare beneficiaries with acute ischemic stroke.J Am Heart Assoc 1, no. 1 (February 2012): 42–50. https://doi.org/10.1161/JAHA.111.000034.
Fonarow GC, Saver JL, Smith EE, Broderick JP, Kleindorfer DO, Sacco RL, et al. Relationship of national institutes of health stroke scale to 30-day mortality in medicare beneficiaries with acute ischemic stroke. J Am Heart Assoc. 2012 Feb;1(1):42–50.
Fonarow, Gregg C., et al. “Relationship of national institutes of health stroke scale to 30-day mortality in medicare beneficiaries with acute ischemic stroke.J Am Heart Assoc, vol. 1, no. 1, Feb. 2012, pp. 42–50. Pubmed, doi:10.1161/JAHA.111.000034.
Fonarow GC, Saver JL, Smith EE, Broderick JP, Kleindorfer DO, Sacco RL, Pan W, Olson DM, Hernandez AF, Peterson ED, Schwamm LH. Relationship of national institutes of health stroke scale to 30-day mortality in medicare beneficiaries with acute ischemic stroke. J Am Heart Assoc. 2012 Feb;1(1):42–50.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

February 2012

Volume

1

Issue

1

Start / End Page

42 / 50

Location

England

Related Subject Headings

  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology