Racial variation in initial stroke severity

Background and Purpose-Blacks experience greater morbidity and mortality fr om stroke than do whites. The degree to which this is due to the severity o f the initial stroke is not known. The objective of this study is to determ ine whether there is a racial difference in initial stroke severity. Methods-A secondary analysis of a prospective cohort of 984 veterans (29.7% black) admitted to any of 9 geographically diverse,Veterans Administration Hospitals for acute stroke between April 1995 and March 1997 was performed . Initial stroke severity was ascertained by using the modified Canadian Ne urological Scale (CNS) applied retrospectively to medical record data. Stro ke severity, unadjusted and adjusted for covariates, was compared between b lack and white patients. Results-Blacks:had greater initial stroke severity than did whites (mean CN S score 7.96 versus 8.32, respectively; P=0.039), With a 0.5-point differen ce on the scale corresponding to a single-level decrement in either speech or strength of half of an extremity. This difference persisted with adjustm ent for other important predictors of stroke severity (P=0.035). However, t here was no significant racial difference in Severity when CNS scores were collapsed into a priori clinically relevant categories. Conclusions-Compared with whites, blacks show greater severity of stroke at hospital admission. It remains uncertain whether the relatively small but significant difference at presentation fully explains the striking racial d ifferences in morbidity and mortality from stroke.