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Death and ADL Dependency After Scoring Zero on the NIHSS: A Swedish Retrospective Registry-Based Study
David Darehed1, Malin Reinholdsson1, Adam Viktorisson1
1Department of Public Health and Clinical Medicine (DD), Sunderby Research Unit, Umeå University; Rehabilitation Medicine Research Group (DD, MR, AV, TA, KSS), Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, and Sahlgrenska University Hospital; Department of Occupational Therapy and Physiotherapy (MR, TA); and Rehabilitation Medicine (KSS), Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden.
Mild strokes with zero points on the National Institutes of Health Stroke Scale (NIHSS) are not always benign. Pre-stroke physical inactivity and older age increase the risk of death and dependency after these mild strokes.
Area of Science:
- Neurology
- Public Health
- Geriatrics
Background:
- Mild strokes, defined as 5 or less on the NIHSS, are common.
- A significant portion of mild stroke patients experience lasting deficits.
- Research on the mildest strokes (0-NIHSS) is limited.
Purpose of the Study:
- To investigate patient characteristics of 0-NIHSS strokes.
- To determine outcomes for patients with 0-NIHSS strokes.
- To identify risk factors for adverse outcomes in 0-NIHSS stroke patients.
Main Methods:
- Retrospective registry-based study.
- Included 6,491 adult stroke patients from Swedish stroke units (2014-2019).
- Main outcome: composite of death and ADL dependency at 3 months post-stroke.
Main Results:
- 1,412 (24%) patients had 0-NIHSS strokes.
- Among these, 6% of previously independent patients were dead or ADL-dependent at 3 months.
- Pre-stroke physical inactivity (OR 2.48) and age (OR 1.05 per year) were significant risk factors.
Conclusions:
- 0-NIHSS strokes can lead to significant adverse outcomes.
- Older age and physical inactivity are key risk factors for poor outcomes.
- These findings highlight the importance of early intervention and risk factor management even in mild strokes.
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