Comparison of the National Institutes of Health Stroke Scale with disability outcome measures in acute stroke trials

FB Young, CJ Weir, KR Lees, GAIN Int Trial Sterring Comm Inves

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Purpose - Acute stroke trials typically use disability scales as their primary end point. Neurologic impairment scales such as the National Institutes of Health Stroke Scale (NIHSS) are possibly more sensitive to change in patient status. We aimed to compare a range of potential NIHSS end points with modified Rankin Scale (mRS) and Barthel Index (BI) end points.

Methods - We simulated a total of 6000 clinical trials, each with 1400 patients. We estimated statistical power for a range of NIHSS end points, including prognosis-adjusted and fixed dichotomized end points. These end points were compared with the BI and mRS dichotomized at 95 and 1, respectively.

Results - The most powerful fixed end point was the NIHSS dichotomized at 1. For prognosis-adjusted outcome, we found greatest power if we defined success as achieving a score of = 95 could justify a reduction in sample size of approximately 68% (95% CI, 67% to 69%) without loss of statistical power.

Conclusions - The NIHSS neurologic scale appears more sensitive than the BI or mRS, allowing smaller sample sizes or greater statistical power. The use of an NIHSS prognosis-adjusted end point could allow therapeutic effects from drugs to be more easily identified.

Original languageEnglish
Pages (from-to)2187-2192
Number of pages6
JournalStroke
Volume36
Issue number10
DOIs
Publication statusPublished - Oct 2005

Keywords

  • acute stroke
  • clinical trial
  • end point determination
  • ACUTE ISCHEMIC-STROKE
  • RANDOMIZED CONTROLLED-TRIAL
  • TISSUE-PLASMINOGEN ACTIVATOR
  • NEUROLOGICAL SCALES
  • GLYCINE ANTAGONIST
  • END-POINTS
  • ECASS
  • NEUROPROTECTION
  • PROUROKINASE
  • RELIABILITY

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