NIHSS predicts outcome better than GCS in intracerebral hemorrhage
Introduction: The National Institutes of Health Stroke Scale (NIHSS) score has been correlated with outcome in ischemic strokes but not intracerebral hemorrhage (ICH). We sought to validate the use of NIHSS in ICH patients by comparing it to outcomes using the Glasgow Coma Scale (GCS) score and volume of ICH. Use of the NIHSS will allow clinicians to follow the outcome of more specific parameters which may be used in clinical trials. Methods: We prospectively followed 61 ICH patients admitted to the Cleveland Clinic within 24 hours of onset. Age, NIHSS, GSC, Barthel index (BI), modified Rankin scale (mRs) were obtained on admission, discharge and at 3 months. An ICH volume was calculated using the AxBxC/2 method from the admission CT scan. Correlation was assessed using the Spearman correlation coefficient (SCC) and 95% CI, with a worst score given to deaths. Patients with a history of ischemic stroke were excluded. The maximum NIHSS for coma was 35. Results: The average age of the patients was 66 years old with 35 females and 26 males. On admission, the average NIHSS was 21 for all patients, 28 for those who died at 3 months and 10 for 3-month survivors. The average NIHSS for 3- month survivors was 3. On admission, the average GCS score was 9 for all patients, 7 for those who died and 12 for 3-month survivors. The average GCS of 3-month survivors was 15. The average BI and mRs were 98 and 0 on admission and 86 and 1 at 3 months for survivors. On admission, the average ICH volume was 49 cc for all patients, 66 cc for those who died at 3 months and 24 cc for 3-month survivors. For admission NIHSS of 18 or greater the 3-month mortality was 82% vs 9% for those with NIHSS < 18 (P<0.001). Admission NIHSS correlated strongly with admission GCS (SCC=0.82, CI 0.68, 0.97) and the two scores correlated similarly with volume (SCC=0.45, CI 0.22, 0.68; GCS SCC=0.40,CI 0.16, 0.63). Impressively, admission NIHSS correlated with the 3 month NIHSS (SCC=0.72, CI 0.53, 0.91), 3-month BI (SCC=0.74, CI 0.55, 0.92), 3-month mRs (SCC=0.72, CI 0.53, 0.91) significantly better than did the GCS (SCC=0.57,0.57 and 0.59 for the NIHSS, BI, and mRs, respectively). Conclusion: The admission NIHSS predicts 3-month survival in ICH patients better than the GCS.