Factors and outcomes associated with National Institutes of Health stroke scale scores in acute ischemic stroke patients undergoing thrombectomy in United States

Adnan I Qureshi; Ibrahim A Bhatti; Syed A Gillani; Rami Fakih; Camilo R Gomez; Chun Shing Kwok

doi:10.1016/j.jstrokecerebrovasdis.2025.108292

Factors and outcomes associated with National Institutes of Health stroke scale scores in acute ischemic stroke patients undergoing thrombectomy in United States

J Stroke Cerebrovasc Dis. 2025 Jun;34(6):108292. doi: 10.1016/j.jstrokecerebrovasdis.2025.108292. Epub 2025 Mar 22.

Authors

Adnan I Qureshi¹, Ibrahim A Bhatti², Syed A Gillani¹, Rami Fakih¹, Camilo R Gomez³, Chun Shing Kwok⁴

Affiliations

¹ Zeenat Qureshi Stroke Institutes, USA; Department of Neurology, University of Missouri, Columbia, USA.
² Zeenat Qureshi Stroke Institutes, USA; Department of Neurology, University of Missouri, Columbia, USA. Electronic address: Ibrahim.a.b@hotmail.com.
³ Department of Neurology, University of Missouri, Columbia, USA.
⁴ Department of Cardiology, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK.

PMID: 40122223
DOI: 10.1016/j.jstrokecerebrovasdis.2025.108292

Abstract

Background and purpose: The National Institutes of Health Stroke Scale (NIHSS) is the standard for assessing neurological deficits in acute ischemic stroke patients undergoing thrombectomy. However, data on NIHSS scores in patients undergoing thrombectomy at national-level studies in the United States are lacking.

Methods: Acute ischemic stroke patients admitted between 2018 and 2021 were identified using ICD-10-CM codes from the Nationwide In-patient Sample, with NIHSS scores categorized into specific strata (0-9, 10-19, 20-29, 30-42). We analyzed the effect of NIHSS scores on in-hospital mortality, routine discharge without palliative care (based on discharge disposition), and length and costs of hospitalization after adjusting for potential confounders.

Results: The NIHSS score strata among 108,990 acute ischemic stroke patients undergoing thrombectomy were: NIHSS score 0-9 (29.6 %), 10-19 (40.6 %), 20-29 (26.4 %), and 30-42 (3.4 %). Patients in the Midwest and West regions (adjusted odds ratio [adjusted OR] = 1.51, p = 0.002 and adjusted OR = 1.63, p < 0.001, respectively), those treated in rural hospitals (adjusted OR = 1.35, p = 0.009) and those who were self-pay (adjusted OR = 1.51, p = 0.048) had higher odds of being in higher NIHSS score strata. Patients in higher NIHSS score strata (NIHSS score 10-19, 20-29, and 30-42 had significantly lower odds of discharge home without palliative care (adjusted OR= 0.50, 0.32, and 0.22 respectively, all p < 0.001) and higher odds of in-hospital mortality (adjusted OR = 1.51, 2.30, and 3.80 respectively, all p < 0.001) compared to those in NIHSS score strata of 0-9. Patients in higher NIHSS score strata had significantly higher hospital stays and higher hospitalization costs.

Conclusions: We provide a comprehensive national-level analysis of NIHSS scores in acute ischemic stroke patients undergoing thrombectomy which may assist in understanding variations in outcomes and resource utilizations in United States.

Keywords: National analysis, Acute ischemic stroke; Nationwide inpatient sample; Thrombectomy, National Institutes of Health Stroke scale.

MeSH terms

Aged
Aged, 80 and over
Databases, Factual
Disability Evaluation*
Female
Functional Status
Hospital Costs
Hospital Mortality
Humans
Ischemic Stroke* / diagnosis
Ischemic Stroke* / economics
Ischemic Stroke* / mortality
Ischemic Stroke* / physiopathology
Ischemic Stroke* / therapy
Length of Stay
Male
Middle Aged
Patient Discharge
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Thrombectomy* / adverse effects
Thrombectomy* / economics
Thrombectomy* / mortality
Time Factors
Treatment Outcome
United States / epidemiology