Abstract
BackgroundIschemic stroke (IS) is a common disease, often resulting in death or disability. Previous studies on prognosis of stroke mainly focused on the baseline condition or modern expensive tests. However, the change of clinical symptoms during acute stage is considerably neglected. In our study, we aim to develop a new prognostic scale to predict the 90-day outcome of IS patients.MethodsIn this retrospective cohort study, a secondary data analysis was performed on 489 patients extracted from 1046 patients of 4 hospitals. A new prognostic scale was constructed to predict the recovery of IS mainly based on the National Institutes of Health Stroke Scale (NIHSS) score, traditional Chinese Medicine (TCM) symptoms & signs and the changes during the first 3 days of patients in the 3 TCM hospitals. Receiver Operating Characteristic (ROC) curve was used to determine the cutoff point for prediction. In the end, the scale was used to test the outcome of IS patients in Xuanwu hospital.ResultsThe new prognostic scale was composed of 8 items including age degree (OR = 3.32; 95 % CI: 1.72–6.42), history of diabetes mellitus (DM) (OR = 2.20; 95 % CI: 1.19–4.08), NIHSS score (OR = 3.08; 95 % CI: 2.16–4.40), anxiety (OR = 3.17; 95 % CI: 1.90–5.29) and irritability (OR = 4.61; 95 % CI: 1.36–15.63) on the 1st day of illness onset, change in NIHSS score (OR = 2.49; 95 % CI: 1.31–4.73), and circumrotating (OR = 7.80; 95 % CI: 1.98–30.64) and tinnitus (OR = 13.25; 95 % CI: 1.55–113.34) during the first 3 days of stroke onset. The total score of the scale was 16.5 and the cutoff point was 9.5, which means patients would have poor outcome at 90 days of stroke onset if the score was higher than 9.5. The new scale was validated on the data of Xuanwu hospital, and the value of its sensitivity, specificity and overall accuracy were 69.6 %, 83.3 % and 75.0 % respectively.ConclusionsThe 8-item scale, mainly based on TCM symptoms, NIHSS score and their changes during the first 3 days, can predict the 90-day outcome for IS patients while it still needs to be further validated and optimized clinically.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-015-0903-1) contains supplementary material, which is available to authorized users.
Highlights
Ischemic stroke (IS) is a common disease, often resulting in death or disability
Study subjects 1046 cases of ischemic stroke patients were recruited between January, 2004 to December, 2009 from inpatient, outpatient, and emergency department settings in 4 hospitals including three traditional Chinese Medicine (TCM) hospitals and one western medicine hospital: Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine, Second Affiliated Hospital of Tianjin University of TCM, Guangdong Provincial Chinese Medicine Hospital and Xuanwu Hospital affiliated to Capital Medical University
Diagnostic criteria (1) Western Medicine diagnostic criteria of ischemic stroke referred to World Health Organization (WHO) criteria and intracranial hemorrhage was further excluded by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scan in the hospital [30]
Summary
Previous studies on prognosis of stroke mainly focused on the baseline condition or modern expensive tests. The judgment of stroke prognosis plays an important role in the formulation of health and economic policy and the choice of treatment programs. Prognosis, affecting both initial therapy and rehabilitation plans of ischemic stroke patients, has been studied for several decades [11]. Previous studies on prognosis of ischemic stroke was mainly focused on the baseline condition or some modern expensive tests like Magnetic Resonance diffusion-weighted Imaging (MR DWI) [12], as well as static signs, such as obviously unconscious [13]. A comprehensive and precise prognosis scale of ischemic stroke still needs to be further developed [15]
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