在美国接受血栓切除术的急性缺血性卒中患者中，与美国国立卫生研究院卒中量表评分相关的因素和结果

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-03-22 DOI:10.1016/j.jstrokecerebrovasdis.2025.108292

Adnan I. Qureshi MD , Ibrahim A. Bhatti MD , Syed A. Gillani MD , Rami Fakih MD , Camilo R. Gomez MD , Chun Shing Kwok MBBS BSc MSc PhD

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引用次数: 0

摘要

背景与目的：美国国立卫生研究院卒中量表（NIHSS）是评估急性缺血性卒中患者行血栓切除术后神经功能缺损的标准。然而，在美国国家一级的研究中，NIHSS评分在接受血栓切除术的患者中缺乏数据。方法：使用全国住院患者样本中的ICD-10-CM代码对2018年至2021年住院的急性缺血性脑卒中患者进行识别，并将NIHSS评分分为特定的分层（0- 9,10 - 19,20 - 29,30 -42）。我们分析了NIHSS评分对住院死亡率、无姑息治疗的常规出院（基于出院处置）、NIS SAH结局指标定义的不良结局以及在调整潜在混杂因素后的住院时间和住院费用的影响。结果：108990例急性缺血性脑卒中取栓患者NIHSS评分分层为：NIHSS评分0 ~ 9分（29.6%）、10 ~ 19分（40.6%）、20 ~ 29分（26.4%）、30 ~ 42分（3.4%）。中西部和西部地区的患者（调整优势比[调整OR] = 1.51,p=0.002，调整OR = 1.63）结论：我们提供了一项全面的全国水平的NIHSS评分分析，该分析可能有助于了解美国急性缺血性卒中患者结局和资源利用的变化。

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Factors and outcomes associated with National Institutes of Health stroke scale scores in acute ischemic stroke patients undergoing thrombectomy in United States

Background and Purpose

The National Institutes of Health Stroke Scale (NIHSS) is the standard for assessing neurological deficits in acute ischemic stroke patients undergoing thrombectomy. However, data on NIHSS scores in patients undergoing thrombectomy at national-level studies in the United States are lacking.

Methods

Acute ischemic stroke patients admitted between 2018 and 2021 were identified using ICD-10-CM codes from the Nationwide In-patient Sample, with NIHSS scores categorized into specific strata (0-9, 10-19, 20-29, 30-42). We analyzed the effect of NIHSS scores on in-hospital mortality, routine discharge without palliative care (based on discharge disposition), and length and costs of hospitalization after adjusting for potential confounders.

Results

The NIHSS score strata among 108,990 acute ischemic stroke patients undergoing thrombectomy were: NIHSS score 0-9 (29.6 %), 10-19 (40.6 %), 20-29 (26.4 %), and 30-42 (3.4 %). Patients in the Midwest and West regions (adjusted odds ratio [adjusted OR] = 1.51, p = 0.002 and adjusted OR = 1.63, p < 0.001, respectively), those treated in rural hospitals (adjusted OR = 1.35, p = 0.009) and those who were self-pay (adjusted OR = 1.51, p = 0.048) had higher odds of being in higher NIHSS score strata. Patients in higher NIHSS score strata (NIHSS score 10-19, 20-29, and 30-42 had significantly lower odds of discharge home without palliative care (adjusted OR= 0.50, 0.32, and 0.22 respectively, all p < 0.001) and higher odds of in-hospital mortality (adjusted OR = 1.51, 2.30, and 3.80 respectively, all p < 0.001) compared to those in NIHSS score strata of 0-9. Patients in higher NIHSS score strata had significantly higher hospital stays and higher hospitalization costs.

Conclusions

We provide a comprehensive national-level analysis of NIHSS scores in acute ischemic stroke patients undergoing thrombectomy which may assist in understanding variations in outcomes and resource utilizations in United States.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.