Relationship of National Institute of Health Stroke Scores [NIHSS] to 90 days mortality in Africa

Abstract

The prognostic value of the NIHSS score has not been evaluated in Africans. The study objective was to compare the NIHSS score at presentation to mortality and prognosis in survivors. We studied 87 patients with acute ischaemic stroke. Their presenting NIHSS score, Clinical features including complications were recorded on admission. Mortality and outcome within 90 days were evaluated using Glasgow Outcome scale. Patients with NIHSS score of 20 and above had mortality of 56.5%, all survivors had severe disability: NIHSS score between 15-19, mortality was 30% and of survivors, 42.8% had severe disability, 33.7% moderate disability and 14.2% recovered completely. With NIHSS score between 6-14, mortality was 24.9% and of survivors, 13.3% had severe disability, 36.6% moderate disability and 50% had good recovery. With NIHSS score of 5 or less there were no deaths and of survivors, 30% had moderate disability and 70% good recovery. It was however observed that if initial NIHSS score remained static or worsened, prognosis was worse. Among such patients those with initial NIHSS score of 20 and above all died, compared with those with NIHSS score of less than 20 who had mortality of 70%. The 30th day mortality index was the best predictor of mortality. High mortality were observed in patients with NIHSS scores 20 and above, presence of neurological complications and static baseline scores. After 90 days, good outcome was observed in patients with the least scores and severe disability in high score survivors.