Stroke severity and early recovery after first-ever ischemic stroke: Results of a hospital-based study in Taiwan

Objective: To assess the relationship between admission stroke severity and outcomes of acute hospitalization in patients with first-ever ischemic stroke in Taiwan. Methods: Data were prospectively collected from 360 first-ever ischemic stroke patients admitted to a medical center within 48 h of stroke onset. Stroke severity was evaluated with NIH stroke scale (NIHSS) and categorized as mild (0-6), moderate (7-15), or severe (16-38). We studied three prespecified discharge outcomes: (1) status based on a combination of NIHSS and modified Barthel index (MBI), (2) subsequent change in neurologic impairments, and (3) subsequent change in functional status. For each outcome, a separate polytomous logistic regression model with least favorable category as the reference group was constructed, controlling confounding factors. Results: Patients (58% male) had mean age 64.9 ± 12.5 (range 18-90), median NIHSS 6 and median MBI 12 on admission. Median length-of-stay was 7 (range 1-122) days; in-hospital deaths 8%. Twenty-two percent patients had excellent status outcome, 33% good. For subsequent change in neurologic impairments, 22% of patients had better outcomes; for sequent change in functional status, better outcomes were noted in 14% of patients. The NIHSS score at admission was strongly associated with outcomes of acute hospitalization after multivariate adjustment. The odds ratio (OR) for moderate (versus mild) stroke patients to achieve excellent status was 0.04 (95% CI, 0.02-0.10), and for severe stroke the OR was less than 0.01 (95% CI, 0-0.05). The OR (95% CI) for moderate stroke patients to have good or improved outcome was 0.19 (0.10-0.36), for severe stroke 0.04 (0.01-0.13). The ORs for moderate and severe (versus mild) stroke patients to have better subsequent change in neurologic impairments were 5.18 (1.94-13.85) and 4.12 (1.38-12.30); to remain stationary 0.43 (0.19-0.96) and 0.15 (0.06-0.36), respectively. Conclusions: In patients with first-ever ischemic stroke in Taiwan, admission NIHSS is predictive of outcome of acute hospitalization.