Abstract TP165: Association of Admission versus 24-Hour NIHSS Score With Early Ambulation After Stroke

Abstract

Introduction: Predicting who will be ambulatory within the first several days after stroke may help support resource allocation, and discharge and rehabilitation planning. The National Institutes of Health Stroke Scale (NIHSS) is commonly used to rate stroke severity. Due to medical intervention or stroke progression, the NIHSS score at admission versus 24 hours can be drastically different. We explored whether presence of leg weakness at admission or 24 hours was most predictive of early ambulation, and other NIHSS score components associated with early ambulation. Methods: A consecutive sample of patients admitted to a stroke unit at a comprehensive stroke center was included in this retrospective study. Initial and 24-hour NIHSS scores were examined in conjunction with various demographic and stroke details. Multivariable logistic regression models identified predictors of ambulation within the first week of admission. Results: Of 513 stroke patients, 273 (53%) were able to walk with or without assistance within the first 3-5 days post-stroke. The multivariable model utilizing the 24-hour NIHSS combined right and left lower extremity weakness scores had greater predictive value (area under the curve [AUC] = 0.85; 95% confidence interval [CI] 0.81 - 0.88) than the initial score (AUC = 0.74; 95% CI 0.69 - 0.78). In the multivariable analysis, 24-hour combined leg weakness (odds ratio [OR] 0.29; 95% CI 0.22 - 0.39), ataxia (OR 0.63; 95% CI 0.43 - 0.91), and sensation (OR 0.58; 95% CI 0.37 - 0.91) scores were all associated with early ambulation capacity. Conclusions: The prediction of early ambulation is more accurate after 24 hours post-stroke. Leg weakness, ataxia, and sensory loss at 24 hours are all negatively associated with ability to ambulate after stroke.