Abstract TP363: Early Changes in Stroke Severity: Characterization and Impact on Patient-Centered Stroke Outcomes

Introduction: Early changes in NIH stroke scale (NIHSS) within the first days after ischemic stroke have been associated with clinical outcomes, however association with patient-centered outcomes is unknown. Predicting outcomes is important for decisions after the acute period. We sought to characterize the magnitude of early NIHSS change and identify its impact on 90-day Stroke Impact Scale-16 (SIS). Methods: Data were collected as part of an ongoing single-center study of recovery for patients with upper extremity weakness. NIHSS at time of presentation (presentation NIHSS) was obtained by chart review and NIHSS at time of enrollment (enrollment NIHSS) was assessed prior to acute hospital discharge. We collected demographic, treatment, imaging, and 90-day outcomes. We used a linear regression to determine the relationship of early NIHSS improvement (presentation-enrollment NIHSS) with 90-day SIS and dichotomized the dataset (early NIHSS improvement ≥3 vs not) to compare predefined clinical variables hypothesized to be early improvement predictors. Results: Study participants (n=72) had median presentation NIHSS of 6 (IQR4-13) and median enrollment NIHSS of 6 (IQR4-10) with a mean of 2.7+/-2.5 days between timepoints. Seventeen subjects improved by ≥3 and 16 worsened by ≥3. Acute treatments were endovascular therapy (ET, n=10) and thrombolysis (tPA, n=16). Early NIHSS improvement was associated with better 90-day SIS (p=0.012). This association remained when subjects who underwent ET or tPA were excluded (p=0.046). Subjects with early NIHSS improvement ≥3 were less likely to have hypertension (15 vs 85%, p=0.039) and more likely to have undergone ET (60 vs 40%, p=0.010), but there were no differences in tPA treatment, infarct volume, days between timepoints, age, or other medical history. Conclusion: This analysis confirms that there are substantial changes in NIHSS in the first days after stroke. Early NIHSS improvement was associated with better 90-day SIS, even when excluding subjects who underwent treatment with ET or tPA suggesting this association also exists for subjects with spontaneous improvement. Early NIHSS improvement may be a useful prognostic tool for patient-centered outcomes after stroke.