Baseline NIH Stroke Scale score strongly predicts outcome after stroke - Areport of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)

Objective: To compare the baseline National Institutes of Health Stroke Sca le (NIHSS) score and the Trial of Org 10172 in Acute Stroke Treatment (TOAS T) stroke subtype as predictors of outcomes at 7 days and 3 months after is chemic stroke. Methods: Using data collected from 1,281 patients enrolled i n a clinical trial, subtype of stroke was categorized using the TOAST class ification, and neurologic impairment at baseline was quantified using the N IHSS. Outcomes were assessed at 7 days and 3 months using the Barthel Index (BI) and the Glasgow Outcome Scale (GOS). An outcome was rated as excellen t if the GOS score was 1 and the BI was 19 or 20 (scale of 0 to 20). Analys es were adjusted for age, sex, race, and history of previous stroke. Result s: The baseline NIHSS score strongly predicted outcome, with one additional point on the NIHSS decreasing the likelihood of excellent outcomes at 7 da ys by 24% and at 3 months by 17%. At 3 months, excellent outcomes were note d in 46% of patients with NIHSS scores of 7 to 10 and in 23% of patients wi th scores of 11 to 15. After multivariate adjustment, lacunar stroke had an odds ratio of 3,1 (95% Cl, 1.5 to 6.4) for an excellent outcome at 3 month s. Conclusions: The NIHSS score strongly predicts the likelihood of a patie nt's recovery after stroke. A score of greater than or equal to 16 forecast s a high probability of death or severe disability whereas a score of less than or equal to 6 forecasts a good recovery. Only the TOAST subtype of lac unar stroke predicts outcomes independent of the NIHSS score.