Stroke Severity Is a Crucial Predictor of Outcome: An International Prospective Validation Study.
BACKGROUND
Stroke is among the leading causes of morbidity and mortality worldwide. Without reliable prediction models and outcome measurements, comparison of care systems is impossible. We analyzed prospectively collected data from 4 countries to explore the importance of stroke severity in outcome prediction.


METHODS AND RESULTS
For 2 months, all acute ischemic stroke patients from the hospitals participating in the Global Comparators Stroke GOAL (Global Outcomes Accelerated Learning) collaboration received a National Institutes of Health Stroke Scale (NIHSS) score on admission and a modified Rankin Scale score at 30 and 90 days. These data were added to the administrative data set, and risk prediction models including age, sex, comorbidity index, and NIHSS were derived for in-hospital death within 7 days, all in-hospital death, and death and good outcome at 30 and 90 days. The relative importance of each variable was assessed using the proportion of explained variation. Of 1034 admissions for acute ischemic stroke, 614 had a full set of NIHSS and both modified Rankin Scale values recorded; of these, 507 patients could be linked to administrative data. The marginal proportion of explained variation was 0.7% to 4.0% for comorbidity index, and 11.3 to 25.0 for NIHSS score. The percentage explained by the model varied by outcome (16.6-29.1%) and was highest for good outcome at 30 and 90 days. There was high agreement between 30- and 90-day modified Rankin Scale scores (weighted κ=0.82).


CONCLUSIONS
In this prospective pilot study, the baseline NIHSS score was essential for prediction of acute ischemic stroke outcomes, followed by age; whereas traditional comorbidity index contributed little to the overall model. Future studies of stroke outcomes between different care systems will benefit from including a baseline NIHSS score.
['Rost|Natalia S|NS|', 'Bottle|Alex|A|', 'Lee|Jin-Moo|JM|', 'Randall|Marc|M|', 'Middleton|Steven|S|', 'Shaw|Louise|L|', 'Thijs|Vincent|V|', 'Rinkel|Gabriel J E|GJ|', 'Hemmen|Thomas M|TM|', '|||']
D015897:Comorbidity D003661:Decision Support Techniques D005060:Europe D017052:Hospital Mortality D006801:Humans D010865:Pilot Projects D011237:Predictive Value of Tests D011379:Prognosis D011446:Prospective Studies D015203:Reproducibility of Results D018570:Risk Assessment D012307:Risk Factors D012720:Severity of Illness Index D020521:Stroke D013997:Time Factors D014481:United States
stroke mortality statistics survival