NIHSS cut point for predicting outcome in supra- vs infratentorial acute ischemic stroke

作者：Sohei Yoshimura, Richard I. Lindley, Cheryl Carcel, Shoichiro Sato, Candice Delcourt, Xia Wang, John Chalmers, Craig S. Anderson, for the ENCHANTED Investigators, ENCHANTED Investigators, Hisatomi Arima, Yining Huang, Jong Sung Kim, Pablo M. Lavados, Tsong‐Hai Lee, Christopher Levi, Mark Parsons, Sheila Cristina Ouriques Martins, Jeyaraj Pandian, Octávio Marques Pontes‐Neto, Tom Robinson, Vijay K. Sharma, Nguyen Huy Thang, Christian Stapf, Ji‐Guang Wang, Joanna M. Wardlaw, Philip M. Bath, Joseph P. Broderick, Andrew M. Demchuk, Geoffrey A. Donnan, Laurent Billot, Qiang Li MBiostat, Mark Woodward, Penny Gordon, Sully Xiomara Fuentes Patarroyo, Dino Benito, Hossein Zareie, Yongjun Cao, Amy Kunchok, Stephen L. Winters, Shelagh B. Coutts, Tom J. Moullaali, Yongjun Cao, Jie Yang, Guojun Wu, Shihong Zhang, Lili Song, Guofang Chen, Lisa Manning, Amit Mistri, Victoria J. Haunton, Xiaoying Chen, Joyce Lim, Sharon Tucker, Leibo Liu, Sully Xiomara Fuentes Patarroyo, Penelope Gordon, Sarah Richtering, Xia Wang, Kerry Jenson, Elizabeth Knight, Elizaveta Ivanova, Emma Thembani, E. Odgers, Elizabeth A. Sanders, Sabrina Small, Ruchita Vaghasiya, Manuela Armenis, Paul S. Donnelly, Merza Ahmad Baig, N. J. Blacklock, B. Naidu, Ravinder Singh, Zhen Xi, Hua Deng, Buliang Cui, Ying Guo, Lingyu He, Ruolan Jia, Nan Li, Wei Li, Mengxiao Liu, Ziwei Xu, Meng Zhang, Ting Zhang, Yan Zhao, Yunjeong In, Su Kim, Jung Eun Ahn, Sul Hwa Kim, Young Lan Hong, Verónica V. Olavarría, Francisca González, Bernardita Portales, Alejandra Malavera, Magda Carla Ouriques Martins Taiwan, Ching‐Yi Wang, S J Ryu, Alice Durham, Hardeep Aujla, Sue Lewin, Tracy Kumar Vietnam, Hong Ha Uyen, Nguyen Anh Giang, Le Thi My Linh, Lê Thị Thuý An, Do Minh Phuong, Pham Vu Bich Ngoc, Nguyen Mai Hang, Nguyen Thi Bich Tran, Ha Thi Thu Hien, Mai Bao Yen, Martín Krause, Miriam Priglinger, Susan Day, S. Jala, Linda Davies, Candice Delcourt, Cheryl Carcel, T. Paraskevaidis, Craig S. Anderson, Tissa Wijeratne, Sherisse Celestino, Linda Law, G. André Ng, Christopher Levi, Ken Nagao, Mark Parsons, Ferdinand Miteff, Neil J. Spratt, Lara Kaauwai, Sheila Cristina Ouriques Martins, Rosane Brondani, Arthur Ferraz de Almeida, Gary M. Weiss, Millene Rodrigues Camilo, M. Portal, Diandra B. Favoretto, Fábio Aguiar-Alves, Francisco Antunes Dias, Clara Barreira, Carla Heloísa Cabral Moro, Alexandre Luiz Longo, R. Liberato, Roberto Ramos Barbosa, Pedro Magalhães, Rodrigo Bazán, Geórgia de Carvalho Braga, Gustavo José Luvizutto, Priscila Watson Ribeiro, Melanie Polin, Lucas Miranda Marques, Fernanda Oliveira, Marco Battaglini, F. Lourenço, Kathleen Ferreira, Kayth Dayane Vieira da Silva, Luís Duarte, Marta Alves, João de Sousa, M. Uhehara, Verónica V. Olavarría, Michael Valenzuela, Alejandro M. Brunser, V. Díaz-Tapia, R. Rivas, C Klapp, L. Carvallo, P. Carvallo, G. Bustamante, Laura Bravo, José Manuel Matamala, Rodrigo Guerrero, Eloy Mansilla, J. Flores, M. Alvarado, Alex F. Herrera, Carolina Reyes, G. Chen, Ping Li, Shaonan Zhou, Wei Liu, L. Liu, Yaohua Tian, Z. Li, Chen C. Liu, Yiwei Cao, Jie Shi, Shoujiang You, Xiaoyi Zhang, Jing Wang, Lidan Wang, Lidan Wang, Z. Zhen, S. Zhang, Xiaofeng Zhang, Min Yan, Lidan Wang, X. Tao, Qilu Zhang, J. Zhang, Yan Li, Ruikun Li, Georgina Cheng, Q. Chen, Y. Zhang, Junshan Zhou, Jean Yang, Ying Liu, Min Xu, X. Wei, Rong Li, H. Liu, Ying Lv, C. Zhang, Xiaoyi Zhang, Jun Xia, Hui Wang, Yi Zhang, Xianchan Li, Y. Wang, Xianchan Li, Aiming Lu, Samuel Chin Wei Tan, Yining Huang, Y. Wang, Longfei Wu, Z. Liu, Song Huang, Ya Gao, L. Wu, H. Sun, J. Zhang, Xiaohong Guo, Ying Lian, Tongren Xu, Deqin Geng, X. Yan, D. Wang, Naisi Zhao, Jufen Liu, Yalan Pan, Hui Wang, Zhiqiang Wang, Yuanjie Niu, Y. Wang, D. Liu, Wei-Sheng Wu, Hui Wang, Lifang Yang, Simin Liu, Shuyang Zhang, D. Wang, Xuexiang Chang, Jufen Liu, Shuguang Wang, D. Wang, Wei Huang, Jean Yang, Anna Song, Xiaoyi Zhang, Mengchen Zou, Bo Hu, L. Zhou, Lingli Sun, Cong Geng, Lili Song, H. Zhang, Yangfeng Wu, Li-Ting Huang, Yuantao Hao, H. Yan, B. Qiao, A. Zhang, Jean Yang, Ying Liu, Jun Feng, Wen-Jun He, X. Liu, Qinghai Huang, Qing Yang, Wen Zheng, Xincun Zhuang, Xiaoling Chen, H. Nie, Li Li, Xintong Wu, Ting Wu, Bo‐Ying Bao, Y. Wang, Xueliang Zeng, Fang‐Qing Guo, Hancheng Dai, Xu Yang, Yuanhua Shao, Xiaoyi Zhang, Shun Li, L. Tai, Lu Xu, L. Wu, Tao Zhang, Y. Zhang, En Xu, Q. Lin, Lingjun Zhan, Junbao Du, Ying‐Ju Lai, Yi Zhou, Hongfei Duan, Qi Cao, Qi Ma, M. Cai. W.H.T. Leung, F.J.G. Silva, Jason Castellanos, M.A. Malavera, E. Solano, Stefano Ricci, E. Caterbi, Sabine Cenciarelli, R Condurso, E. Gallinella, Laura Greco, Cindy Marando, S. Mastrocola, A. Mattioni, Tatiana Mazzoli, Chiara Padiglioni, I. Sicilia, I. Corea, Arianna Guidubaldi, Sara Micheli, Mali Barbi, K.B. Lee, H.W. Hwang, Jihoon Cha, Dong Hun Kim, Hyun Wook Nah, J.S. Kim, Sun U. Kwon, Dong‐Wha Kang, Y.J. Kim, Beom Joon Kim, J.M. Park, Kyung Tae Kang, Beom Joon Kim, Ohseong Kwon, J.J. Lee, Young Woo Kim, Yang‐Ha Hwang, Hyuksool Kwon, E.G. Kim, Jiwon Seo, J.H. Jung, J.M. Kim, Zisun Kim, Joung‐Ho Rha, H.K. Park, C.W. Yoon, Jaseong Koo, Kyoung Bun Lee, T. Kim, Anna Ahn, Jang‐Hee Kim, Hee‐Jung Song, Hayeong Jeong, Jae-Deok Lim, Sang Min Park, Y.J. Kim, Tae-Jin Song, E.J. Jung, Woo‐Keun Seo, Kelly Oh, Hyun Jin Ji, D.E. Kim, Wi‐Sun Ryu, C. Irgens, Eivind Berge, Bernard P.L. Chan, Hock Luen Teoh, Aftab Ahmad, Prakash Paliwal, Jason J. Ong, Tsung‐Han Lee, Chen‐June Seak, Ting‐Yu Chang, H.L. Po Y.J.Lin, Chieh Chou, Chia‐Wei Liou, Chieh Chou, Chia‐Wei Liou, Thean Yen Tan, Chuanfu Liu, Henry Cheng, Huey-Juan Lin, Chien‐Ming Yang, Hui Shen, Cheng‐Yen Chang, Pei‐Lun Kuo, R.T. Lin C.F.Chen, M.N. Wu, C.H. Chen, Shin‐Joe Yeh, Liang-Po Hsieh, Joshua D. Lee, Meng Lee, Yuwen Huang, Yuwen Huang, C.Y. Lin, C-H Wu, C. C. Yen, Yu‐Tzu Chang, Yueh‐Han Hsu, Nijasri C. Suwanwela, A. Chutinet Y.Likitjaroen, Duangnapa Roongpiboonsopit, S. Charnwut, Christine Roffe, R. Sanyal, Girish Muddegowda, Helen Maguire, Jeanette Grocott, Kriti Kalra, Dulka Manawadu, Nyma Sikondari, J Aeron‐Thomas, Richard Perry, L. Howaniec, Krishna Patel, A. Banaras, C. Watchurst W. Sunman, Nikola Sprigg, Sunil Munshi, Philip M. Bath, Nicola Gilzeane, Caroline R. Richardson, B. Moynihan, Bhakti K. Patel, Usman Khan, Rita Ghatala, B. Clarke O. Halse, Helen E. Jenkins, Paul Bentley, Marius Venter, A. Kar A. Dyker, A. Dixit, M.O. Hossain, Stephen Louw, Ascobat Gani, M. Davis:, L. Sztriha, James Teo, James Teo, T. Ajao, Francis K.L. Chan, M. Alao J. Kallingal, Mary Johnes, Linda Harrison, V. O'Loughlin, Z. Naing T. England, R. Donnelly, Jon Scott, M. Maddula, J. Beavan D. Tryambake, David Broughton, A. Bergin L. Dixon, John Coyle, Amit Mistri, K. Musarrat, Lisa Manning, Thompson Robinson, D. Eveson E. Warburton, Jennifer Mitchell, Diana J. Day, Nicholas Church, E. Amis D. Chadha, Peter Anderson, Mitali Kini, Deborah Walstow, Christopher Price, Helen Rodgers, N. Weir, Martin James, Hayley Kingwell, A. Bouring, H. Kingwell, Sharon Keenan, Francesco P. Cappuccio, Anthony Kenton, Bander Dallol, Sheila Nyabadza, K. Rashed, S. Board, Diane P. Wood, C Buckley, L. Balian P. Datta, M. P. Carpenter, Richard Davey, A. Stanners, Antonia Blank, K. Harkness, A. Ali, E. Richards, E. Richards, C. Athulathmudali, Karen Stocks, Karen Stocks, E Barbon, Ahamad Hassan, Linetty Makawa, Emelda Veraque, Mary Kambafwile, David Hargroves, Ibrahim Balogun, Tom R. Webb, Luke Cowie, Mary Joan MacLeod, Steven B. Wilkinson, Joanne Reid, Robert Clarke, J. Furnace S. Andole, Naveen Gadapa, S. Choudhary, Kevin Dunne, Sofia Dima, David Bruce, G. Rogers, Eli M. Brown, Scott C. Cooper, M A Nasar, Aleksandra Rajapakse, I. Wynter L. Sekaran, S. Sethuraman, Frances Justin, Matthew C. Tate, T. Iyngkaran M. Wani, Tal Anjum, Martin James, A Bowring, H. Kingwell, Sharon Keenan, T. Nguyen Huy, A. Truong Le Tuan, Luis Cam, Mingchuan Ba, B. Pham Nguyen H. Nguyen Thi Thu, M. Nguyen Duy, D. Ngo Van A. Nguyen Dat, T. Mai Duy, C. Nguyen Van, P. Dao Viet S. Nguyen Hoanh, S. Pham Phuoc, T. Tran Van, B. Doan Thi H. Hoang Quoc, T. Vo Van, Kyuseok Kim, Te Ba, K. Dao Duy, Q. Pham Thi Ngoc · 发表于：Neurology · 年份：2018 · DOI：10.1212/wnl.0000000000006437 · 被引用次数：27 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Stroke Rehabilitation and Recovery

OBJECTIVE: To determine the optimal cut point on the NIH Stroke Scale (NIHSS) for predicting poor 90-day clinical outcome in patients with supratentorial and infratentorial acute ischemic stroke (AIS). METHODS: Data are from participants of the alteplase-dose arm of the randomized controlled trial, Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Associations between baseline characteristics of clinically defined supratentorial and infratentorial AIS patients and poor functional outcome, defined by scores 3-6 on the modified Rankin Scale, were evaluated in logistic regression models, with area under the curve (AUC) receiver operating characteristics defining the optimal NIHSS predictor cut point. RESULTS: < 0.001). NIHSS cut points for poor outcome were 10 (AUC 76, sensitivity 65%, specificity 73%) and 6 (AUC 69, sensitivity 72%, specificity 56%) in supratentorial and infratentorial AIS, respectively. There was no significant difference in functional outcome or symptomatic intracranial hemorrhage between AIS types. CONCLUSIONS: In thrombolysis-eligible AIS patients, the NIHSS may underestimate clinical severity for infratentorial compared to supratentorial lesions for a similar prognosis for recovery. Because thrombolysis treatment has low effect on stroke outcome in patients with infratentorial AIS when baseline NIHSS score is more than 6, additional treatment such as endovascular treatment should be considered to improve stroke outcome. CLINICALTR...