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NIH stroke scale and unfavourable outcomes in acute ischaemic stroke: retrospective study
  1. Maiara Silva Tramonte1,
  2. Ana Claudia Pires Carvalho1,
  3. Ana Elisa Vayego Fornazari1,
  4. Gustavo Di Lorenzo Villas Boas1,
  5. Gabriel Pinheiro Modolo1,
  6. Natalia Cristina Ferreira1,
  7. Marcos Christiano Lange2,
  8. Marcos Ferreira Minicucci1,
  9. Rodrigo Bazan1 and
  10. Laura Cardia Gomes Lopes1
  1. 1Faculdade de Medicina Campus de Botucatu, Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu, São Paulo, Brazil
  2. 2Departamento de Neurologia, Universidade Federal do Parana, Curitiba, Paraná, Brazil
  1. Correspondence to Dr Maiara Silva Tramonte, Neurologia e Psiquiatria, Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu 18618-687, São Paulo, Brazil; maiaratramonte{at}


Objectives To evaluate the determining factors of severe functional impairment (SFI) outcome at discharge and in-hospital mortality in patients who had an acute ischaemic stroke and thus favouring early implementation of primary palliative care (PC).

Methods A retrospective descriptive study by the analysis of 515 patients who had an acute ischaemic stroke admitted at stroke unit, aged≥18 years, from January 2017 to December 2018. Previous clinical and functional status data, National Institute of Health Stroke Scale (NIHSS) on admission, and data related to the evolution during hospitalisation were evaluated, relating them to the SFI outcome at discharge and death. The significance level was set at 5%.

Results Of 515 patients included, 15% (77) died, 23.3%(120) had an SFI outcome and 9.1% (47) were evaluated by the PC team. It was observed that NIHSS Score≥16 is responsible for a 15.5-fold increase in the occurrence of death outcome. The presence of atrial fibrillation was responsible for a 3.5-fold increase in the risk of this outcome.

Conclusion NIHSS Score is an independent predictor of in-hospital death and SFI outcomes at discharge. Knowledge about the prognosis and risk of developing unfavourable outcomes is important for planning the care of patients affected by a potentially fatal and limiting acute vascular insult.

  • Stroke
  • Prognosis
  • Neurological conditions

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  • Contributors Study conception and design: MST, RB, LCGL. Data analysis and interpretation: MST, RB, LCGL, MFM. Data collection: MST, ACPC, AEVF, GDLVB. Article writing: MST. Critical revision of the text: RB, LCGL, GPM, NCF, MCL. Final article approval: RB, LCGL, MCL. Statistical analysis: MST, RB, MFM, LCGL. General responsibility for the study: MST, RB, LCGL.

  • Funding The present study had a scientific initiation grant funded by FAPESP 2020/09947-4.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.