Abstract 2185: The Historical Stroke Severity Score Predicts Stroke Progression in TIA and Minor Stroke
TIA and minor stroke have a high risk of early neurological deterioration. Many of these early deteriorations are from progression of the presenting event. It has previously been shown that patients with large early neurological improvement are at high risk of subsequent deterioration. In this study we prospectively generated a scoring system for assessing the most severe historical deficit.
Methods: Consecutive patients presenting with TIA or minor stroke (NIHSS<4) were prospectively enrolled in the prospective CATCH imaging study, if a stroke neurologist assessed them and they had a CT/CTA (Aortic arch to vertex) completed within 24 hours of symptom onset. The Historical Stroke Severity Score (HSSS) was developed in advance of the study to allow measurement of the severity of a patients’ worst deficits. The HSSS was scored based upon the clinical history and ranged from 0-11 points and included assessment of: a. Level of consciousness (alert (0), drowsy (1), Unconscious (2)); b. Speech disturbance (normal (0), dysarthria only (1), mild aphasia (2), severe aphasia or mute (3)); c. Arm motor power (normal (0), mild weakness or heaviness (1), moderate weakness (2), severe weakness (3)); d. Leg motor power (normal (0), mild weakness or heaviness (1), moderate weakness (2), severe weakness (3)); e. Sensory symptoms (normal (0), mild sensory (1), severe sensory (2)). The individual components of the score and the total score were assessed for their ability to predict symptom progression. Symptom progression was defined as a worsening of the presenting symptoms related to the initial event and not as a distinct second event.
Results: 510 patients were enrolled and 90-day follow up was available in 499 (98%). These patients were assessed early with a median time from symptom onset to CTA was 5.5 hours (IQR: 6.4 hours). The HSSS was rated immediately after patients were enrolled in the study - ie immediately after the CT/CTA. 19 (3.7% 95% CI 2.3-5.8) patients had symptom progression with a median time to event of one day. The progression rates for low (0-3), intermediate (4-7) and high (8-11) total scores were 2.7%, 6% and 14%. The total HSSS was associated with symptom progression (ROC 0.68 (0.56-0.79). Only the motor severity components of the HSSS were predictive of symptom progression (arm motor weakness (p=0.015) and leg motor weakness (p=0.006). Therefore the score could be simplified to include only motor historical severity of the arm and leg (ROC 0.68 (0.57-0.8) with a total score range of 0-6.
Conclusions: The taking of a detailed history is highly relevant. A score based on the historical description of how severe the worst deficits were is able to predict symptom progression in a TIA and minor stroke population assessed early in the emergency department. Severity of motor symptoms appears to best predict symptom progression in TIA and minor stroke patients.
- © 2012 by American Heart Association, Inc.