Comparing Early National Institutes of Health Stroke Scale Versus 90‐Day Modified Rankin Scale Outcomes in Acute Ischemic Stroke Trials: A Systematic Review and Analysis Article Swipe
Leon A. Rinkel
,
Johanna M. Ospel
,
Manon Kappelhof
,
Arshia Sehgal
,
Rosalie McDonough
,
Michael Tymianski
,
Michael D. Hill
,
Mayank Goyal
,
Aravind Ganesh
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1161/jaha.124.040304
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1161/jaha.124.040304
Background Early National Institutes of Health Stroke Scale (NIHSS) assessment may provide practical benefits over 90‐day modified Rankin Scale (mRS), but it is unclear how it compares in adjudicating randomized clinical trial (RCT) results in acute ischemic stroke. Methods and Results We searched Ovid Medline (inception to April 1, 2023) and included RCTs of acute therapies for acute ischemic stroke with data for both 90‐day mRS and NIHSS within 7 days. Primary outcome was agreement between trial results (classified as positive, negative, or neutral) based on 24‐hour NIHSS and 90‐day mRS scores. We additionally assessed agreement for 2‐hour, 48‐hour, 72‐ to 96‐hour, and 5‐ to 7‐day NIHSS scores. We aimed to validate our findings using individual patient data from the ESCAPE (Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke) and ESCAPE‐NA1 (Safety and Efficacy of Nerinetide [NA‐1] in Subjects Undergoing Endovascular Thrombectomy for Stroke) RCTs. We included 116 trials (44 387 patients), contributing 165 NIHSS assessments. The 24‐hour NIHSS scores resulted in the same classification as 90‐day mRS scores in 61/73 (83.6%) trials (Cohen's kappa, 0.64 [95% CI: 0.45–0.83] and Gwet's agreement coefficient 1, 0.79 [95% CI: 0.67–0.90]). Agreement was not statistically different by timing of NIHSS assessments (range 75%–100%, P =0.33). Individual patient data showed higher agreement for assessments between 48 hours and 7 days, varying by NIHSS dichotomization cutoffs (NIHSS score, 0–2; 2 hours, 56.6%; 24 hours, 66.6%; 48 hours, 71.8%; 5–7 days: 76.5%, P <0.01; NIHSS score, 0–7; 2 hours, 72.8%; 24 hours, 80.5%; 48 hours, 83.1%; 5–7 days: 84.7%, P <0.01). Conclusions The 24‐hour NIHSS scores aligned with 90‐day mRS scores in 84% of RCT results, indicating intermediate‐to‐good agreement. However, individual patient data showed that early NIHSS risks misclassifying around 1/4 patients. These data contribute to a better understanding of the nuances of early NIHSS score as an outcome in acute ischemic stroke RCTs.
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Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.1161/jaha.124.040304
- OA Status
- gold
- Cited By
- 2
- References
- 141
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4409797910
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4409797910Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1161/jaha.124.040304Digital Object Identifier
- Title
-
Comparing Early National Institutes of Health Stroke Scale Versus 90‐Day Modified Rankin Scale Outcomes in Acute Ischemic Stroke Trials: A Systematic Review and AnalysisWork title
- Type
-
reviewOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2025Year of publication
- Publication date
-
2025-04-26Full publication date if available
- Authors
-
Leon A. Rinkel, Johanna M. Ospel, Manon Kappelhof, Arshia Sehgal, Rosalie McDonough, Michael Tymianski, Michael D. Hill, Mayank Goyal, Aravind GaneshList of authors in order
- Landing page
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https://doi.org/10.1161/jaha.124.040304Publisher landing page
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
- OA URL
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https://doi.org/10.1161/jaha.124.040304Direct OA link when available
- Concepts
-
Medicine, Modified Rankin Scale, Randomized controlled trial, Stroke (engine), Clinical trial, Internal medicine, Physical therapy, Ischemic stroke, Emergency medicine, Ischemia, Mechanical engineering, EngineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
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2Total citation count in OpenAlex
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2025: 2Per-year citation counts (last 5 years)
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141Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.from | 118 |
| abstract_inverted_index.over | 14 |
| abstract_inverted_index.same | 164 |
| abstract_inverted_index.that | 279 |
| abstract_inverted_index.with | 60, 262 |
| abstract_inverted_index.(RCT) | 32 |
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| abstract_inverted_index.61/73 | 171 |
| abstract_inverted_index.72‐ | 99 |
| abstract_inverted_index.April | 47 |
| abstract_inverted_index.Early | 1 |
| abstract_inverted_index.NIHSS | 67, 87, 106, 155, 159, 197, 219, 239, 259, 281, 299 |
| abstract_inverted_index.RCTs. | 145, 308 |
| abstract_inverted_index.Rapid | 124 |
| abstract_inverted_index.Scale | 7, 18 |
| abstract_inverted_index.These | 287 |
| abstract_inverted_index.acute | 35, 54, 57, 305 |
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| abstract_inverted_index.based | 84 |
| abstract_inverted_index.days, | 216 |
| abstract_inverted_index.days. | 70 |
| abstract_inverted_index.days: | 235, 252 |
| abstract_inverted_index.early | 280, 298 |
| abstract_inverted_index.hours | 213 |
| abstract_inverted_index.risks | 282 |
| abstract_inverted_index.score | 300 |
| abstract_inverted_index.trial | 31, 76 |
| abstract_inverted_index.using | 114 |
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| abstract_inverted_index.(mRS), | 19 |
| abstract_inverted_index.(range | 199 |
| abstract_inverted_index.0–2; | 224 |
| abstract_inverted_index.0–7; | 241 |
| abstract_inverted_index.56.6%; | 227 |
| abstract_inverted_index.66.6%; | 230 |
| abstract_inverted_index.71.8%; | 233 |
| abstract_inverted_index.72.8%; | 244 |
| abstract_inverted_index.76.5%, | 236 |
| abstract_inverted_index.80.5%; | 247 |
| abstract_inverted_index.83.1%; | 250 |
| abstract_inverted_index.84.7%, | 253 |
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| abstract_inverted_index.Gwet's | 181 |
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| abstract_inverted_index.Rankin | 17 |
| abstract_inverted_index.Stroke | 6 |
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| abstract_inverted_index.better | 292 |
| abstract_inverted_index.higher | 207 |
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| abstract_inverted_index.kappa, | 175 |
| abstract_inverted_index.score, | 223, 240 |
| abstract_inverted_index.scores | 160, 169, 260, 265 |
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| abstract_inverted_index.stroke | 59, 307 |
| abstract_inverted_index.timing | 195 |
| abstract_inverted_index.trials | 149, 173 |
| abstract_inverted_index.within | 68 |
| abstract_inverted_index.(83.6%) | 172 |
| abstract_inverted_index.(NIHSS) | 8 |
| abstract_inverted_index.(Safety | 132 |
| abstract_inverted_index.7‐day | 105 |
| abstract_inverted_index.=0.33). | 202 |
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| abstract_inverted_index.Methods | 38 |
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| abstract_inverted_index.Results | 40 |
| abstract_inverted_index.Stroke) | 129, 144 |
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| abstract_inverted_index.between | 75, 211 |
| abstract_inverted_index.cutoffs | 221 |
| abstract_inverted_index.nuances | 296 |
| abstract_inverted_index.outcome | 72, 303 |
| abstract_inverted_index.patient | 116, 204, 276 |
| abstract_inverted_index.provide | 11 |
| abstract_inverted_index.results | 33, 77 |
| abstract_inverted_index.scores. | 91, 107 |
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| abstract_inverted_index.Ischemic | 128 |
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| abstract_inverted_index.findings | 113 |
| abstract_inverted_index.included | 51, 147 |
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| abstract_inverted_index.results, | 270 |
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| abstract_inverted_index.2‐hour, | 97 |
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| abstract_inverted_index.Treatment | 126 |
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| abstract_inverted_index.positive, | 80 |
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| abstract_inverted_index.therapies | 55 |
| abstract_inverted_index.<0.01). | 255 |
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| abstract_inverted_index.96‐hour, | 101 |
| abstract_inverted_index.Assessment | 122 |
| abstract_inverted_index.Background | 0 |
| abstract_inverted_index.Individual | 203 |
| abstract_inverted_index.Institutes | 3 |
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| abstract_inverted_index.Undergoing | 140 |
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| abstract_inverted_index.assessment | 9 |
| abstract_inverted_index.contribute | 289 |
| abstract_inverted_index.indicating | 271 |
| abstract_inverted_index.individual | 115, 275 |
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| abstract_inverted_index.(Randomized | 121 |
| abstract_inverted_index.(classified | 78 |
| abstract_inverted_index.75%–100%, | 200 |
| abstract_inverted_index.Conclusions | 256 |
| abstract_inverted_index.assessments | 198, 210 |
| abstract_inverted_index.coefficient | 183 |
| abstract_inverted_index.0.45–0.83] | 179 |
| abstract_inverted_index.ESCAPE‐NA1 | 131 |
| abstract_inverted_index.Endovascular | 125, 141 |
| abstract_inverted_index.Thrombectomy | 142 |
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| abstract_inverted_index.adjudicating | 28 |
| abstract_inverted_index.assessments. | 156 |
| abstract_inverted_index.contributing | 153 |
| abstract_inverted_index.statistically | 192 |
| abstract_inverted_index.understanding | 293 |
| abstract_inverted_index.0.67–0.90]). | 188 |
| abstract_inverted_index.classification | 165 |
| abstract_inverted_index.misclassifying | 283 |
| abstract_inverted_index.dichotomization | 220 |
| abstract_inverted_index.intermediate‐to‐good | 272 |
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| cited_by_percentile_year.min | 95 |
| countries_distinct_count | 2 |
| institutions_distinct_count | 9 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.4099999964237213 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.94666509 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |