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National Institutes of Health Stroke Scale in patients with primary intracerebral hemorrhage

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Abstract

Background

The National Institutes of Health Stroke Scale (NIHSS) is able to predict mortality and functional outcome in patients with ischemic stroke. Its role in primary intracerebral hemorrhage (ICH) is not clear. The objective of our study was to investigate whether NIHSS is a reliable instrument of clinical monitoring and correlates with mortality and functional outcome in ICH.

Methods

One hundred fifty-six consecutive subjects with primary ICH were included. We evaluated NIHSS at admission. The functional state after a 30-day and a 3-month-long follow-up was assessed by the modified Rankin Scale (mRS). Spearman’s rank correlation coefficient analysis was used for statistics. Sensitivity, specificity, positive predictive value, negative predictive value, global accuracy, and ROC curve were computed using the median score 7 as NIHSS cutoff and the score 4 as mRS cutoff.

Results

Median NIHSS score at admission was 7 (16–4); the mean (± SD) was 10.82 (± 8.27). Thirty-two patients (20.5%) died within 30 days and other 22 (14.1%) within 3 months. The median mRS score at 3 months was 4 (6–1); the mean (± SD) was 3.38 (± 2.42). We found a statistically significant correlation between initial NIHSS score and mRS score after 30 days (0.74) and 3 months (0.66, p < 0.01). Sensitivity was 93.5 and 92.2%, specificity 82.3 and 69.6%, and GA 87.8 and 80.8%, respectively, at 1 and 3 months. The 1- and 3-month ROC curves comparing initial NIHSS and mRS showed a fitted area as 0.914 and 0.833, respectively.

Conclusions

NIHSS is a reliable tool of clinical monitoring and correlates with 30-day and 3-month mortality and functional outcome in subjects with ICH.

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Authors and Affiliations

  1. Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova and San Martino Teaching Hospital, Largo Daneo 3, 16132, Genoa, Italy

    Cinzia Finocchi, Maurizio Balestrino, Gianluigi Mancardi & Carlo Gandolfo

  2. Department of Neurosciences, San Martino Teaching Hospital, Largo Benzi 3, 16132, Genoa, Italy

    Laura Malfatto & Carlo Serrati

Authors
  1. Cinzia Finocchi
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  2. Maurizio Balestrino
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  3. Laura Malfatto
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  4. Gianluigi Mancardi
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  5. Carlo Serrati
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  6. Carlo Gandolfo
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Correspondence to Cinzia Finocchi.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Finocchi, C., Balestrino, M., Malfatto, L. et al. National Institutes of Health Stroke Scale in patients with primary intracerebral hemorrhage. Neurol Sci 39, 1751–1755 (2018). https://doi.org/10.1007/s10072-018-3495-y

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  • DOI: https://doi.org/10.1007/s10072-018-3495-y

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