Original ArticleInterconversion of the National Institutes of Health Stroke Scale and Scandinavian Stroke Scale in Acute Stroke
Section snippets
Data
Data from 5 acute stroke trials included in Virtual International Stroke Trials Archive,6 where both NIHSS and SSS had been recorded at baseline and day 90, were included. Information on age, sex, side of stroke, tissue plasminogen activator use, stroke type, and functional outcome at 90 days (modified Rankin Scale and Barthel Index) was also provided.
Statistical Methods
Conversion equations were developed using linear regression (both unadjusted, and adjusted for age and sex) using 50% of the data selected at
Results
Data from 5 completed acute stroke trials were included, with a mean time to treatment of 7 hours. In all, 2004 patients had baseline data collected on both the SSS and NIHSS. A total of 1628 patients had day-90 data available for both scales, and 1505 patients had both baseline and day-90 data. The patients included are reasonably representative of patients in stroke trials, with a mean age of 66 (SD 11.8) and slightly more men (57%) than women.
Discussion
The results show that NIHSS and SSS can be derived from each other in both directions with reasonable to good degrees of reliability. Mathematic models using data measured at baseline had an acceptable level of fit between the actual and predictive values. In particular, the variation was always less than one point on either scale. The models produced with data collected at 90 days postrandomization had a higher goodness of fit, although converting SSS to NIHSS predicted higher values of NIHSS
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Dr. Gray is supported, in part, by The Stroke Association (UK) and Medical Research Council (UK). Prof. Bath is Stroke Association Professor of Stroke Medicine.
Presented as a poster at the European Stroke Conference in Glasgow in May 2008.