Accuracy of Serial National Institutes of Health Stroke Scale
Scores to Identify Artery Status in Acute Ischemic Stroke

J 2007

Accuracy of Serial National Institutes of Health Stroke Scale Scores to Identify Artery Status in Acute Ischemic Stroke

MIKULÍK, Robert, Marc RIBO, Michael HILL, James GROTTA, Marc MALKOFF et. al.

Basic information

Original name

Accuracy of Serial National Institutes of Health Stroke Scale Scores to Identify Artery Status in Acute Ischemic Stroke

Name in Czech

Presnost opakovaneho vysetreni NIHSS skore v identifikaci rekanalizace a pretrvavajici okluze u pacientu s akutnim mozkovym infarktem

Authors

MIKULÍK, Robert, Marc RIBO, Michael HILL, James GROTTA, Marc MALKOFF, Carlos MOLINA, Marta RUBIERA, Raquel DELGADO-MEDEROS, Jose ALVAREZ-SABIN and Andrei V. ALEXANDROV

Edition

Circulation, 2007, 0009-7322

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30000 3. Medical and Health Sciences

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 12.755

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1161/CIRCULATIONAHA.106.651026

UT WoS

000246664200012

Keywords in English

stroke; reperfusion; ultrasonography; thrombolysis

Abstract

ORIG CZ

V originále

Background: Early recovery after intravenous thrombolysis can be observed in stroke; however, the utility of measuring clinical improvement to assess artery status has not been established. We sought to determine the accuracy of serial National Institutes of Health Stroke Scale (NIHSS) scores to detect complete early recanalization of the middle cerebral artery. Methods and Results: Data from the CLOTBUST trial (Combined Lysis of Thrombus in Brain Ischemia Using Transcranial Ultrasound and Systemic tPA) were used to determine the most sensitive and specific NIHSS derived parameter to identify complete recanalization. Then, reproducibility was tested against a separate patient population (Barcelona data set). NIHSS scores were determined before tissue plasminogen activator bolus and at 60 and 120 minutes in both data sets. Receiver operating characteristic curves were used to compare test performance. The accuracy of individual cutoffs was demonstrated by sensitivity, specificity, and positive and negative predictive values. A total of 122 patients in the CLOTBUST data set and 98 in the Barcelona data set received 0.9 mg/kg intravenous tissue plasminogen activator [mean age 69 plus minus 12 versus 72 plus minus 12 years, 57% male versus 51% male, median NIHSS 16 versus 17 points, mean time from onset to treatment 140 plus minus 32 versus 177 plus minus 59 minutes, and complete recanalization of the middle cerebral artery in 19% versus 17%). For identification of recanalization, an NIHSS score reduction of 40% or more offered the best tradeoff, with sensitivity, specificity, positive predictive value, and negative predictive value of 65%, 85%, 50%, and 91% at 60 minutes and 74%, 80%, 58%, and 89% at 120 minutes, respectively. Test performance was equal in the Barcelona data set. Conclusions:Relative changes in serial NIHSS scores can serve as a simple clinical indicator of arterial status after intravenous thrombolysis. Accuracy parameters are affected by the process of recanalization and its varying clinical significance.

In Czech

NIHSS skore je jednoduchym indikatorem rekanalizace a pretrvavajici okluze u pacientu s akutnim mozkovym infarktem

Citovat

MIKULÍK, Robert, Marc RIBO, Michael HILL, James GROTTA, Marc MALKOFF, Carlos MOLINA, Marta RUBIERA, Raquel DELGADO-MEDEROS, Jose ALVAREZ-SABIN and Andrei V. ALEXANDROV. Accuracy of Serial National Institutes of Health Stroke Scale Scores to Identify Artery Status in Acute Ischemic Stroke. Circulation. 2007, vol. 115, No 20, p. 2660-2665. ISSN 0009-7322. Available from: https://dx.doi.org/10.1161/CIRCULATIONAHA.106.651026.

@article{768467,
   author = {Mikulík, Robert and Ribo, Marc and Hill, Michael and Grotta, James and Malkoff, Marc and Molina, Carlos and Rubiera, Marta and DelgadoandMederos, Raquel and AlvarezandSabin, Jose and Alexandrov, Andrei V.},
   article_number = {20},
   doi = {http://dx.doi.org/10.1161/CIRCULATIONAHA.106.651026},
   keywords = {stroke; reperfusion; ultrasonography; thrombolysis},
   language = {eng},
   issn = {0009-7322},
   journal = {Circulation},
   title = {Accuracy of Serial National Institutes of Health Stroke Scale Scores to Identify Artery Status in Acute Ischemic Stroke},
   volume = {115},
   year = {2007}
}

TY  - JOUR
ID  - 768467
AU  - Mikulík, Robert - Ribo, Marc - Hill, Michael - Grotta, James - Malkoff, Marc - Molina, Carlos - Rubiera, Marta - Delgado-Mederos, Raquel - Alvarez-Sabin, Jose - Alexandrov, Andrei V.
PY  - 2007
TI  - Accuracy of Serial National Institutes of Health Stroke Scale Scores to Identify Artery Status in Acute Ischemic Stroke
JF  - Circulation
VL  - 115
IS  - 20
SP  - 2660-2665
EP  - 2660-2665
SN  - 00097322
KW  - stroke
KW  - reperfusion
KW  - ultrasonography
KW  - thrombolysis
N2  - Background: Early recovery after intravenous thrombolysis can be observed in stroke; however, the utility of measuring clinical improvement to assess artery status has not been established. We sought to determine the accuracy of serial National Institutes of Health Stroke Scale (NIHSS) scores to detect complete early recanalization of the middle cerebral artery. Methods and Results: Data from the CLOTBUST trial (Combined Lysis of Thrombus in Brain Ischemia Using Transcranial Ultrasound and Systemic tPA) were used to determine the most sensitive and specific NIHSS derived parameter to identify complete recanalization. Then, reproducibility was tested against a separate patient population (Barcelona data set). NIHSS scores were determined before tissue plasminogen activator bolus and at 60 and 120 minutes in both data sets. Receiver operating characteristic curves were used to compare test performance. The accuracy of individual cutoffs was demonstrated by sensitivity, specificity, and positive and negative predictive values. A total of 122 patients in the CLOTBUST data set and 98 in the Barcelona data set received 0.9 mg/kg intravenous tissue plasminogen activator [mean age 69 plus minus 12 versus 72 plus minus 12 years, 57% male versus 51% male, median NIHSS 16 versus 17 points, mean time from onset to treatment 140 plus minus 32 versus 177 plus minus 59 minutes, and complete recanalization of the middle cerebral artery in 19% versus 17%). For identification of recanalization, an NIHSS score reduction of 40% or more offered the best tradeoff, with sensitivity, specificity, positive predictive value, and negative predictive value of 65%, 85%, 50%, and 91% at 60 minutes and 74%, 80%, 58%, and 89% at 120 minutes, respectively. Test performance was equal in the Barcelona data set. Conclusions:Relative changes in serial NIHSS scores can serve as a simple clinical indicator of arterial status after intravenous thrombolysis. Accuracy parameters are affected by the process of recanalization and its varying clinical significance.
ER  -

MIKULÍK, Robert, Marc RIBO, Michael HILL, James GROTTA, Marc MALKOFF, Carlos MOLINA, Marta RUBIERA, Raquel DELGADO-MEDEROS, Jose ALVAREZ-SABIN and Andrei V. ALEXANDROV. Accuracy of Serial National Institutes of Health Stroke Scale Scores to Identify Artery Status in Acute Ischemic Stroke. \textit{Circulation}. 2007, vol.~115, No~20, p.~2660-2665. ISSN~0009-7322. Available from: https://dx.doi.org/10.1161/CIRCULATIONAHA.106.651026.

Detailed Information on Publication Record