- 作者：Tai Hwan Park ; MD ; PhD&lowast ; ; Keun-Sik Hong ; MD ; PhD&dagger ; ; nrhks@paik.ac.kr ; Jay Chol Choi ; MD ; PhD&Dagger ; ; Pamela Song ; MD&dagger ; ; Ji Sung Lee ; PhD§ ; ; Juneyoung Lee ; PhD§ ; ; Jong-Moo Park ; MD ; PhD¡¬ ; Kyusik Kang ; MD ; PhD¡¬ ; Kyung Bok Lee ; MD ; PhD¶ ; ; Yong-Jin Cho ; MD ; PhD&dagger ; ; Gustavo Saposnik ; MD ; MSc# ; Moon-Ku Han ; MD ; PhD&lowast ; &lowast ; ; Hee-Joon Bae ; MD ; PhD&lowast ; &lowast ;
- 关键词：Minor stroke definition ; acute ischemic stroke ; thrombolysis ; outcome ; NINDS-TPA trials
- 刊名：Journal of Stroke and Cerebrovascular Diseases
- 出版年：2013
- 出版时间：May, 2013
- 年：2013
- 卷：22
- 期：4
- 页码：482-490
- 全文大小：510 K
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?=?0 or an NIHSS score?=?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.