This is hardly news to anyone with a clinical practice, but it’s a topic rarely addressed in stroke trials – that patients with identical NIHSS can have a wide range of downstream disability.
This is a retrospective analysis of the VISTA registry, which collates non-thrombolysis acute stroke trial data, and is generally useful for identifying predictors of long-term prognosis and outcomes. These authors used six hypothesized “profiles” of stroke syndromes with distinct constellations of disabilities, and matched a total of 10,271 patients from their database to one of the six. Using their most disabling stroke subtype profile as reference, the authors noted three different syndromes – with median NIHSS 10, 9, and 7 – all had similar likelihood of favorable outcomes. However, even though the NIHSS and good outcomes were similar, the disabilities and clinical profile associated with one of these cohorts translated to twice as likely to be deceased at 90 days. In essence – similar “numbers”, but very different outcomes.
There’s nothing here usable for direct knowledge translation – but, it does hearken back to my oft-repeated statements regarding the heterogeneity of stroke syndromes, outcomes, and likelihood of benefit or harm from pharmacologic revascularization. Quite simply, data sources such as this – and those including patients from thrombolysis trials – ought be better utilized to predict patient-specific outcomes.
“National Institutes of Health Stroke Scale Item Profiles as Predictor of Patient Outcome”
http://www.ncbi.nlm.nih.gov/pubmed/25503546