Validation of Minor Stroke Definitions for Thrombolysis Decision Making
- Authors
- Park, Tai Hwan; Hong, Keun-Sik; Choi, Jay Chol; Song, Pamela; Lee, Ji Sung; Lee, Juneyoung; Park, Jong-Moo; Kang, Kyusik; Lee, Kyung Bok; Cho, Yong-Jin; Saposnik, Gustavo; Han, Moon-Ku; Bae, Hee-Joon
- Issue Date
- May-2013
- Publisher
- W. B. Saunders Co., Ltd.
- Keywords
- Minor stroke definition; acute ischemic stroke; thrombolysis; outcome; NINDS-TPA trials
- Citation
- Journal of Stroke and Cerebrovascular Diseases, v.22, no.4, pp 482 - 490
- Pages
- 9
- Journal Title
- Journal of Stroke and Cerebrovascular Diseases
- Volume
- 22
- Number
- 4
- Start Page
- 482
- End Page
- 490
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/13738
- DOI
- 10.1016/j.jstrokecerebrovasdis.2013.03.006
- ISSN
- 1052-3057
1532-8511
- Abstract
- Background: Patients with low National Institutes of Health Stroke Scale (NIHSS) scores are frequently excluded from thrombolysis, but more than 25% of them remain disabled. We sought to define a validated minor stroke definition to reduce the inappropriate treatment exclusion. Methods: From an outcome database, untreated patients with an NIHSS score of 5 or less presenting within a 4.5-hour window were identified and 3-month modified Rankin Scale (mRS) outcomes were analyzed according to individual isolated symptoms and total NIHSS scores. The validity of the following minor stroke definitions were assessed: (1) the National Institute of Neurological Disorders and Stroke Tissue Plasminogen Activator (NINDS-TPA) trials' definition, (2) the total NIHSS score, varying a cutoff point from 0 to 4, and (3) our proposed definition that included an NIHSS score 5 0 or an NIHSS score 5 1 on the items of level of consciousness (LOC), gaze, facial palsy, sensory, or dysarthria. Results: Of 647 patients, 172 patients (26.6%) had a 3-month unfavorable outcome (mRS score 2-6). Favorable outcome was achieved in more than 80% of patients with an NIHSS score of 1 or less or with an isolated symptom on the LOC, gaze, facial palsy, sensory, or dysarthria item. In contrast, unfavorable outcome proportion was more than 25% in patients with an NIHSS score of 2 or more. When the NINDS-TPA trials' definition, our definition, or the definition of an NIHSS score of 1 or less were applied, more than 75% of patients with an unfavorable outcome were defined as a non-minor stroke and less than 15% of patients with an unfavorable outcome were defined as a minor stroke. Conclusion: Implementation of an optimal definition of minor stroke into thrombolysis decision-making process would decrease the unfavorable outcomes in patients with low NIHSS scores.
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Collections - College of Medicine > Department of Neurology > 1. Journal Articles
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