Pooja, L (2023) A Study on the Comparison of NIHSS, APACHE Ⅱ, and Scandinavian Stroke Scale in the Prediction of Early Mortality (≤7 Days Post Stroke) of Acute Ischemic Stroke Patients – Premise - in a Tertiary Care Hospital. Masters thesis, Madras Medical College, Chennai.
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Abstract
BACKGROUND: Stroke has been the second greatest cause of death worldwide and one of the major causes of mortality and morbidity in adults. The estimated 30-day case fatality rate following a first ischemic stroke varies widely across nations, although it is expected to be between 16 and 23% globally. Among these, much of the mortality occurs less than 7 days’ post-stroke. It is therefore essential to have PREMISE Score that helps in predicting the early stroke mortality. One of the few eminent scales of neurological assessment useful in predicting early mortality of stroke patients are the NIHSS, APACHE Ⅱ AND SCANDINAVIAN STROKE SCALE. OBJECTIVES: To compare the efficiency of NIHSS, APACHE Ⅱ AND SCANDINAVIAN STROKE SCALE in predicting the early mortality (≤7 days’ post stroke) of acute ischemic stroke patients – Premise - admitted in a tertiary care hospital. METHODOLOGY: This was a prospective observational study conducted in the Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai for 6 months (May 2022 to October 2022). The study included 200 patients with Acute Ischemic Stroke, who met the inclusion and exclusion criteria. A detailed clinical history was elicited, neurological examination was recorded and baseline blood investigations were done. The APACHE II, NIHSS and SCANDINAVIAN STROKE SCALE scores were assessed at admission within the first day (24 hours) of stroke. Outcome of the patient was assessed as discharge/death from the hospital. RESULTS: ROC curve was generated to predict the cut-off value of these scores in patients who died. In NIHSS score, the cut-off value was 11.5, with an AUC of 0.737. In SSS Score, the cut-off value was 16.5, with an AUC of 0.852. In APACHE Ⅱ score, the cut-off value was 12.5, with an AUC of 0.794. All these had a significant p-value of < 0.0001. Even though the AUC for APACHE Ⅱ Score and SSS were slightly larger when compared with NIHSS, there were no statistically significant differences between these scales. The PPV - NPV of both SSS Scores and APACHE Ⅱ were 74.49% - 75.49% and 73.68% - 73.33% respectively. The PPV and NPV of NIHSS Score were 65.74% - 70.65% respectively. The sensitivity and specificity of NIHSS were 72.45% and 63.73% respectively. The accuracy was 68%. The sensitivity and specificity of SSS were 74.49% and 75.49% respectively. The accuracy was 75%. The sensitivity and specificity of APACHE Ⅱ were 71.43% and 75.49% respectively. The accuracy was 73.50%. CONCLUSION: From the results obtained from this study, it was found that the scores SSS and APACHE Ⅱ were equally as good as the NIHSS Score in the prediction of early mortality (≤7 days’ post stroke) of acute ischemic stroke patients.
| Item Type: | Thesis (Masters) |
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| Additional Information: | Reg.No.200120100522 |
| Uncontrolled Keywords: | National Institutes of Health Stroke Scale (NIHSS), Acute Physiology and Chronic Health Evaluation II (APACHE Ⅱ), Scandinavian Stroke Scale, Prediction, Early Mortality (≤7 Days Post Stroke), Acute Ischemic Stroke Patients – Premise, Tertiary Care Hospital. |
| Subjects: | MEDICAL > General Medicine > MEDICAL > General Medicine |
| Depositing User: | Thavamani K |
| Date Deposited: | 17 May 2022 10:44 |
| Last Modified: | 17 Mar 2024 14:51 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19530 |
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