An article in the July issue of the Archives of Neurology reports that increasing stroke severity, as measured by the National Institutes of Health Stroke Scale, increases the likelihood that stroke patients who are treated with the rt-PA clot-dissolving drug will be discharged to rehabilitation or nursing homes, rather than to their own homes.
A stroke is a sudden and often severe problem in the nervous system, usually caused either by blood flow to part of the brain being obstructed (blood clot) or by bleeding into the brain. The National Stroke Association recently reported that three quarters of a million Americans will have a stroke or brain attack this year.
The National Institutes of Health Stroke Scale (NIHSS) is a widely used quantitative measure of stroke-related neurological deficit that includes items to assess level of consciousness, gaze, visual fields, facial palsy, motor strength, ataxia (wobbliness), sensation, language, dysarthria (slurred speech), and extinction or inattention.
Daniel J. Schlegel, M.D., of the University of Pennsylvania Medical Center, Philadelphia, and colleagues conducted a study to determine whether the NIHSS score predicts disposition in stroke patients treated with thrombolysis (administration of medication to dissolve a clot). The study included 546 patients from three countries with acute ischemic stroke, who were treated with recombinant tissue plasminogen activator (rt-PA), a powerful "clot-buster" that is infused through the vein. Medical records were reviewed for demographic information, vascular risk factors, location of stroke, initial NIHSS score, acute hospital disposition, and complications of symptomatic or asymptomatic intracerebral hemorrhage (ICH; bleeding within the brain tissue).
Of the 546 patients included in the study, 44 percent were discharged to home, 42 percent to rehabilitation, and 14 percent to a nursing facility.
"This study demonstrates that stroke severity, as measured by the NIHSS, is the predominant predictor of discharge destination after initial hospitalization for patients with acute ischemic stroke treated with intravenous rt-PA," the authors report.