Abstract
Background: Both Glasgow Coma Scale (GCS) and NIH Stroke Scale (NIHSS) are commonly used as serial assessment tools in ICH, however, the NIHSS lacks formal validation in this population. Methods: We prospectively collected ICH assessments, imaging, and outcome data. Direct comparisons of discrimination were made using GCS and NIHSS on prediction of 24-hour poor functional outcome (mRS-3-6) and hematoma volume >30cm 3 using ROC analysis; c statistics were calculated and compared with DeLong test. Results: 672 ICH patients (mean age 62±14 years; 56% men; median ICH score = 1, IQR 0-2; median ICH volume 7cm 3 , IQR 2-19) were included in the analysis. Median NIHSS and GCS were 8 (IQR 3-18) and 15 (IQR 7-15) respectively. NIHSS correlated strongly to GCS (r -0.773; p<0.001). NIHSS (c statistic: 0.91; 95%CI: 0.89-0.93) discriminated better than GCS (c statistic: 0.78; 95%CI: 0.75-0.81) for 24-hour poor functional outcome (DeLong p<0.001; Figure 1A). NIHSS (c statistic: 0.82; 95%CI: 0.78-0.86) also discriminated better than GCS (c statistic: 0.78; 95%CI: 0.73-0.83) for large hematoma volume (DeLong p=0.029; Figure 1B). Conclusions: The NIHSS has greater discriminative power than GCS to identify patients with poor functional outcomes and large hematoma volumes.
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