Validity of National Institutes of Health Stroke Scale for Severity of Stroke to Predict Mortality Among Patients Presenting With Symptoms of Stroke

Umar Farooque; Ashok Kumar Lohano; Ashok Kumar; Sundas Karimi; Farah Yasmin; Vijaya Chaitanya Bollampally; Margil R Ranpariya

doi:10.7759/cureus.10255

Validity of National Institutes of Health Stroke Scale for Severity of Stroke to Predict Mortality Among Patients Presenting With Symptoms of Stroke

Cureus. 2020 Sep 5;12(9):e10255. doi: 10.7759/cureus.10255.

Authors

Umar Farooque¹, Ashok Kumar Lohano², Ashok Kumar³, Sundas Karimi⁴, Farah Yasmin⁵, Vijaya Chaitanya Bollampally⁶, Margil R Ranpariya⁷

Affiliations

¹ Neurology, Dow University of Health Sciences, Karachi, PAK.
² Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, PAK.
³ Internal Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, PAK.
⁴ General Surgery, Combined Military Hospital, Karachi, PAK.
⁵ Cardiology, Dow University of Health Sciences, Karachi, PAK.
⁶ Neurological Surgery, Capital Medical University, Beijing, CHN.
⁷ Internal Medicine, Surat Municipal Institute of Medical Education and Research, Surat, IND.

Abstract

Introduction Cerebrovascular accident (CVA), also termed as stroke, is the third leading cause of mortality and the most common cause of disability globally. The National Institutes of Health Stroke Scale (NIHSS) is a valid assessment tool utilized to determine the severity of the stroke and can be used to prioritize patients to design treatment plans, rehabilitation, and better clinical outcomes. The primary objective of this study was to determine the validity of the NIHSS to predict mortality among patients presenting with symptoms of a stroke. Material and methods This was a descriptive case-series conducted over a period of six months between September 2019 and February 2020 at a tertiary care hospital in Nawabshah, Pakistan. The sample population included 141 patients admitted within 24 hours of the onset of symptoms of a stroke. A neurological examination of the patients was performed. On admission, stroke severity was evaluated with the NIHSS. After an initial clinical evaluation, patients underwent a non-enhanced computed tomography (CT) scan of the brain. The score of NIHSS and mortality at 72 hours were recorded on the pre-defined proforma by the investigators. All statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0 (Armonk, NY: IBM Corp). Results The mean age of the participants was 52.37±8.61 years. 68.1% of patients were hypertensive, 29.1% were diabetic, and 36.9% of patients were found with hyperlipidemia. The mortality rate was 41.1%. The mean NIHSS score was 16.68±6.72 points. The findings of this study demonstrated that the score of 14.9% cases was good (0-6 points), the score of 29.1% cases was moderate (7-15 points), and the score of 56% cases was poor (≥16 points). There was a significant association of NIHSS score with mortality (p<0.001). Conclusions Baseline NIHSS score has a profound association with mortality after acute stroke. It can help clinicians decide whether to provide thrombolytic treatment, rehabilitation or a combination of both in these patients and decrease the mortality rate. However, more studies are needed to potentiate these conclusions.

Keywords: health stroke scale system; humans; mortality; national institutes of health stroke scale; stroke; validity.