Retrospective Study on National Institutes of Health Stroke Scale as a Predictor of Patient Recovery After Stroke

Background: The National Institutes of Health Stroke Scale (NIHSS) was designed primarily as a research instrument and is used in clinical settings. Its use has not yet been examined as a predictor of patient functional outcomes and prognosis in a community hospital setting. Objectives: The aim of this study was to determine the effectiveness of baseline NIHSS score in predicting patient functionality and disposition at discharge in a designated stroke center at a community hospital. Methods: The study population included every transient ischemic attack and stroke encounter seen at our community hospital over the past 6 years (n = 2909). Neurological impairment at baseline was quantified using the NIHSS score on the patient's arrival. Outcomes included the patient's discharge disposition (expired or alive) and ambulatory status at discharge. Results were adjusted for age, gender, race, and stroke, myocardial infarction, diabetes, and hypertension history. Analysis was done using R-based statistical tools. Results: Baseline NIHSS score was a strong predictor of both patient discharge disposition and ambulatory status. After adjusting for confounding factors, with every 1 point increase in the stroke scale at baseline, there was a 2.3 times increased likelihood of mortality and 3 times increased likelihood in worsening of ambulatory function. Conclusions: In our community hospital setting, the NIHSS score was found to be a strong predictor of patient recovery after stroke. The NIHSS score at baseline may be important for clinicians to consider before patient management decisions and counseling.