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Abstract TP69: Minimum NIHSS Score To Qualify For IV tPA


 BACKGROUND:
 Frequently patients with ischemic stroke are excluded from IV tPA therapy because of mild deficits. Often a minimal score on the NIHSS is used to identify mild stroke patients, but some argue to specially weight motor and language deficits. We examined the outcomes of patients with Acute Ischemic Stroke (AIS) who did not receive IV tPA using four definitions of a “mild” deficit using the total and itemized NIHSS at baseline with the aim to identity patients with a mild deficit that highly predicts good outcome when not treated with thrombolysis. Additionally we examined if any single item on the NIHSS in mild stroke patients predict poor outcomes.
 
 
 METHODS:
 We included all adult patients with mild (NIHSS 0-4) AIS from the UCSD SPOTRIAS Database from 2004-2012; excluded patients who received thrombolysis (IV or IA) or had a pre-stroke mRS >0. We analyzed baseline demographics (age, sex, race, HTN, DM, afib), total NIHSS, NIHSS items (normal or abnormal) and 90-day mRS. We evaluated four definitions of mild deficits: 1) total NIHSS 0-4; 2) NIHSS 0-4 AND arm (Q5) AND leg weakness (Q6) 0-1, AND aphasia (Q9) 0-1; 3) NIHSS 0-4 AND Q5,6,9=0; 4) NIHSS 0-4 AND Q5+6+9<2. Good outcome was defined as 90-day mRS 0-1.
 
 
 RESULTS:
 A total of 147 patients were included (definition #1), under mild #2 we identified 111, #3 78 and #4 106 patients. Good outcome was achieved in 70.8%, 70.3, 74.4% and 70.8% of each definition. No NIHSS item (0 vs >0) correlated with poor outcome in mild patients.
 
 
 CONCLUSION:
 We found no significant difference in outcome prediction when weighing motor and language deficit over the overall NIHSS <5. In the patients with mild stroke, no specific NIHSS scoring item predicted poor outcome.
