AUTHOR=Kazaryan Suzie A. , Shkirkova Kristina , Saver Jeffrey L. , Liebeskind David S. , Starkman Sidney , Bulic Sebina , Poblete Roy , Kim-Tenser May , Guo Shujing , Conwit Robin , Villablanca Pablo , Hamilton Scott , Sanossian Nerses 

TITLE=The National Institutes of Health Stroke Scale is comparable to the ICH score in predicting outcomes in spontaneous acute intracerebral hemorrhage

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1401793

DOI=10.3389/fneur.2024.1401793

ISSN=1664-2295

ABSTRACT=Background: Validating the National Institutes of Health NIH Stroke Scale (NIHSS) as a tool to assess deficit severity and prognosis in patients with acute intracerebral hemorrhage would harmonize the assessment of intracerebral hemorrhage (ICH) and acute ischemic stroke patients, enable clinical use of a readily implementable and non-imaging dependent prognostic tool, and improve monitoring of ICH care quality in administrative data sets. 

Methods: Among randomized trial ICH patients, assessment of relation between NIHSS scores early after Emergency Department arrival and 3-month outcomes of dependency or death (modified Rankin Scale, mRS 3-6) and case-fatality. NIHSS predictive performance was compared to a current standard prognostic scale, the Intracerebral Hemorrhage Score (ICH Score).  

Results: Among the 384 patients, mean age was 65 (±13), 66% male, NIHSS median 16 (IQR 9-25), mean initial hematoma volume 29 mL (±38), and ICH Score median 1 (IQR 0-2). At 3-months, modified Rankin Scale (mRS) was median 4 (IQR 2-6), dependency or death occurred in 70% and case-fatality in 26%. NIHSS and ICH Score were strongly correlated (r=0.73) and each was strongly correlated with 90d mRS (NIHSS, r=0.61; ICH score, r=0.62). The NIHSS performed comparably to the ICH Score in predicting both dependency or death (c=0.80 vs. 0.80, p=0.83) and case-fatality (c=0.78 vs. 0.80, p=0.29). At thresholded values, the NIHSS predicted dependency or death with 74.1% accuracy (NIHSS 17.5) and case-fatality with 75.0% accuracy (NIHSS 18.5). 

Conclusions: The NIHSS forecasts 3-month functional and case-fatality outcomes with accuracy comparable to the ICH Score. Widely documented in routine clinical care and administrative data, the NIHSS can serve as a valuable measure for clinical prognostication, therapy development, and case-mix risk-adjustment in ICH patients.