TY - JOUR
T1 - Validation of minor stroke definitions for thrombolysis decision making
AU - Park, Tai Hwan
AU - Hong, Keun Sik
AU - Choi, Jay Chol
AU - Song, Pamela
AU - Lee, Ji Sung
AU - Lee, Juneyoung
AU - Park, Jong Moo
AU - Kang, Kyusik
AU - Lee, Kyung Bok
AU - Cho, Yong Jin
AU - Saposnik, Gustavo
AU - Han, Moon Ku
AU - Bae, Hee Joon
N1 - Funding Information:
Funding: This work was supported by the 2013 Inje University research grant (K.-S.H.).
Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2013
Y1 - 2013
N2 - Background: Patients with low National Institutes of Health Stroke Scale (NIHSS) scores are frequently excluded from thrombolysis, but more than 25% of them remain disabled. We sought to define a validated minor stroke definition to reduce the inappropriate treatment exclusion. Methods: From an outcome database, untreated patients with an NIHSS score of 5 or less presenting within a 4.5-hour window were identified and 3-month modified Rankin Scale (mRS) outcomes were analyzed according to individual isolated symptoms and total NIHSS scores. The validity of the following minor stroke definitions were assessed: (1) the National Institute of Neurological Disorders and Stroke Tissue Plasminogen Activator (NINDS-TPA) trials' definition, (2) the total NIHSS score, varying a cutoff point from 0 to 4, and (3) our proposed definition that included an NIHSS score = 0 or an NIHSS score = 1 on the items of level of consciousness (LOC), gaze, facial palsy, sensory, or dysarthria. Results: Of 647 patients, 172 patients (26.6%) had a 3-month unfavorable outcome (mRS score 2-6). Favorable outcome was achieved in more than 80% of patients with an NIHSS score of 1 or less or with an isolated symptom on the LOC, gaze, facial palsy, sensory, or dysarthria item. In contrast, unfavorable outcome proportion was more than 25% in patients with an NIHSS score of 2 or more. When the NINDS-TPA trials' definition, our definition, or the definition of an NIHSS score of 1 or less were applied, more than 75% of patients with an unfavorable outcome were defined as a non-minor stroke and less than 15% of patients with an unfavorable outcome were defined as a minor stroke. Conclusion: Implementation of an optimal definition of minor stroke into thrombolysis decision-making process would decrease the unfavorable outcomes in patients with low NIHSS scores.
AB - Background: Patients with low National Institutes of Health Stroke Scale (NIHSS) scores are frequently excluded from thrombolysis, but more than 25% of them remain disabled. We sought to define a validated minor stroke definition to reduce the inappropriate treatment exclusion. Methods: From an outcome database, untreated patients with an NIHSS score of 5 or less presenting within a 4.5-hour window were identified and 3-month modified Rankin Scale (mRS) outcomes were analyzed according to individual isolated symptoms and total NIHSS scores. The validity of the following minor stroke definitions were assessed: (1) the National Institute of Neurological Disorders and Stroke Tissue Plasminogen Activator (NINDS-TPA) trials' definition, (2) the total NIHSS score, varying a cutoff point from 0 to 4, and (3) our proposed definition that included an NIHSS score = 0 or an NIHSS score = 1 on the items of level of consciousness (LOC), gaze, facial palsy, sensory, or dysarthria. Results: Of 647 patients, 172 patients (26.6%) had a 3-month unfavorable outcome (mRS score 2-6). Favorable outcome was achieved in more than 80% of patients with an NIHSS score of 1 or less or with an isolated symptom on the LOC, gaze, facial palsy, sensory, or dysarthria item. In contrast, unfavorable outcome proportion was more than 25% in patients with an NIHSS score of 2 or more. When the NINDS-TPA trials' definition, our definition, or the definition of an NIHSS score of 1 or less were applied, more than 75% of patients with an unfavorable outcome were defined as a non-minor stroke and less than 15% of patients with an unfavorable outcome were defined as a minor stroke. Conclusion: Implementation of an optimal definition of minor stroke into thrombolysis decision-making process would decrease the unfavorable outcomes in patients with low NIHSS scores.
KW - Minor stroke definition
KW - NINDS-TPA trials
KW - acute ischemic stroke
KW - outcome
KW - thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=84877010650&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84877010650&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2013.03.006
DO - 10.1016/j.jstrokecerebrovasdis.2013.03.006
M3 - Article
C2 - 23545318
AN - SCOPUS:84877010650
SN - 1052-3057
VL - 22
SP - 482
EP - 490
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 4
ER -