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J Korean Soc Emerg Med > Volume 17(5); 2006 > Article
Journal of The Korean Society of Emergency Medicine 2006;17(5): 438-446.
Initial Prognosis Predictors of Functional Recovery in Acute Ischemic Stroke
Seo Rin Jung, Seung Ryu, Bum Jin Oh, Won Kim, Kyoung Soo Lim
1Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. bjoh@amc.seoul.kr
2Department of Emergency Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea.
Emergency physicians are often asked to predict a patient's functional outcome after an acute stroke. However, very little information is usually available to a physician to help predict the likelihood of severe permanent disability. The purpose of this study was to determine useful Initial prognostic predictors in patients with an acute stroke presenting to the emergency department.
Between March 1, 2004 and May 31, 2004, we analyzed 74 patients diagnosed to have an acute stroke by diffusion weighted magnetic resonance imaging obtained within 24 hours from symptom onset at the emergency department. Seven factors were evaluated as prospective variables including The National Institutes of Health Stroke Scale (NIHSS) measured by emergency physician (NIHSSEM) and neurologist (NIHSS-NR) at the time of presentation to the emergency department. The outcome variables were Barthel Index (BI), modified Rankin Scale (mRS), and the NIHSS measured at the time of discharge from hospital.
The intraclass correlation coefficient between NIHSS-EM and NIHSS-NR was 0.94 (p < 0.001). History of stroke, gender, NIHSS-EM, large vessel disease and lacuna infarctions were statistically significant outcome predictors. In a multivariate logistic regression analyses, NIHSSEM was the only independent variable that correlated with NIHSS, mRS, and BI at hospital discharge.
Among the many prognostic predictors studied, the NIHSS appeared to be the only independent variable showing a correlation with the patients's prognosis. The NIHSS perfomed in the emergency department may help emergency physicians provide more accurate initial prognosis in an acute stroke patient.
Key words: Cerebrovascular accident, Acute, Prognosis
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