CLINICAL OUTCOME OF STROKE PATIENTS BASED ON THE NATIONAL INSTITUTES OF HEALTH STROKE SCALE (NIHSS) IN A TERTIARY HOSPITAL
DOI:
https://doi.org/10.21776/ub.mnj.2023.009.01.4Keywords:
Clinical outcome, NIHSS, StrokeAbstract
Background: Stroke is the second leading cause of death and the third cause of disability globally. Clinical outcomes caused by stroke are varied and influenced by various factors.
Objective: This study aims to describe the clinical outcome of stroke patients based on neurological deficit using NIHSS at Dr. Hasan Sadikin General Hospital, Bandung.
Methods: This study is a retrospective descriptive, cross-sectional study using secondary data from medical records recruited between January 2019 – December 2019 at the Department of Neurology Dr. Hasan Sadikin General Hospital Bandung with the total sampling method. Variables include demographic data, risk factors, and clinical characteristics. Neurological deficit was assessed using NIHSS. Data were analyzed and presented in the form of tables.
Results: There were 202 subjects eligible for this study, including ischemic (71.8%) and intracerebral hemorrhage (28.2%) stroke patients. Most of the subjects were male (53%), aged ≥60 years (50,5%), presenting with onset >6 hours (72.3%), and had hypertension (92,1%). Most of the subjects have a moderate stroke (n=102;50.5%) based on the NIHSS score at admission and mild stroke (n=117;57.9%) based on the NIHSS score at discharge, with a motor deficit as the most common neurological deficit found.
Conclusion: The majority of stroke patients presented with a moderate stroke on admission and had a clinical improvement during hospital treatment, with most of the patients experiencing a mild stroke on discharge based on NIHSS score. The motor deficit is the most common neurological deficit that affects clinical outcomes.
Downloads
References
World Health Organization. Leading Causes of Death and Disability: A visual summary of global and regional trends 2000-2019 [Internet]. [cited 2021 Jan 25]. Available from:
https://www.who.int/data/stories/leading-causes-of-death-and-disability-2000-2019-a-visual-summary
Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: A global response is needed. Bull World Health Organ; 2016. 94(9):634A-635A. DOI: 10.2471/BLT.16.181636
Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan. Laporan Nasional Riskesdas 2018 [Internet]. Badan Penelitian dan Pengembangan Kesehatan. Jakarta, Indonesia: Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan; 2019. Available from: http://labdata.litbang.kemkes.go.id/images/download/laporan/RKD/2018/Laporan_Nasional_RKD2018_FINAL.pdf
World Health Organization. International classification of impairments, disabilities, and handicaps. Int J Rehabil Res; 1980.
Lyden P. Using the National Institutes of Health Stroke Scale. Stroke; 2017. Feb;48(2):513–9.
DOI: 10.1161/STROKEAHA.116.015434
Demchuk AM, Buchan AM. Predictors of stroke outcome. Neurol Clin; 2000. 18(2):455–73.
DOI: 10.1016/S0733-8619(05)70202-4
Boehme AK, Esenwa C, Elkind MSV. Stroke risk factors, genetics, and prevention. Circ Res; 2017. 120(3):472–95.
DOI: 10.1161/CIRCRESAHA.116.308398
Kasemsap N, Vorasoot N, Kongbunkiat K, Peansukwech U, Tiamkao S, Sawanyawisuth K. Impact of intravenous thrombolysis on length of hospital stay in cases of acute ischemic stroke. Neuropsychiatr Dis Treat; 2018. 14:259–64. DOI: 10.2147/NDT.S151836
Siagian T, Savitra AR. Gambaran Faktor risiko kejadian stroke pada pasien rawat inap di rumah sakit Universitas Kristen Indonesia. Bunga Rampai Saintifika FK UKI; 2016. 1. Available from: http://repository.uki.ac.id/995/
Choudhury MJH, Chowdhury MTI, Nayeem A, Jahan WA. Modifiable and non-modifiable risk factors of stroke: A review update. J Natl Inst Neurosci Bangladesh; 2015. 1(1):22–6.
DOI: 10.3329/jninb.v1i1.22944
Yousufuddin M, Young N. Aging and ischemic stroke. Aging (Albany NY); 2019. May 1. 11(9):2542–4.
DOI: 10.18632/aging.101931
Matuja SS, Munseri P, Khanbhai K. The burden and outcomes of stroke in young adults at a tertiary hospital in Tanzania: A comparison with older adults. BMC Neurol; 2020. 20(1):1–10.
Sealy-Jefferson S, Wing JJ, Sánchez BN, Brown DL, Meurer WJ, Smith MA, et al. Age- and ethnic-specific sex differences in stroke risk. Gend Med; 2012. Apr;9(2):121–8. DOI: 10.1016/j.genm.2012.02.002
Mitta N, Sreedharan SE, Sarma SP, Sylaja PN. Women and stroke: Different, yet similar. Cerebrovasc Dis Extra; 2021. 11(3):106–11. DOI: 10.1159/000519540
Alawieh A, Zhao J, Feng W. Factors affecting post-stroke motor recovery: Implications on neurotherapy after brain injury. Behav Brain Res; 2018. Mar;340:94–101. DOI: 10.1016/j.bbr.2016.08.029
Dinata CA, Safrita YS, Sastri S. Gambaran faktor risiko dan tipe stroke pada pasien rawat inap di bagian penyakit dalam RSUD Kabupaten Solok Selatan Periode 1 Januari 2010 - 31 Juni 2012. J Kesehat Andalas; 2013. May 1;2(2):57.
DOI: /10.25077/jka.v2i2.119
Habibi-Koolaee M, Shahmoradi L, Niakan Kalhori SR, Ghannadan H, Younesi E. Prevalence of stroke risk factors and their distribution based on stroke subtypes in Gorgan: A retrospective hospital-based study 2015-2016. Neurol Res Int; 2018. 2018.
Willmot M, Leonardi-Bee J, Bath PMW. High Blood pressure in acute stroke and subsequent outcome a systematic review. Hypertension; 2004. 43(1):18–24. DOI: 10.1161/01.HYP.0000105052.65787.35
Kamel H, Healey JS. Cardioembolic stroke. Circ Res; 2017. Feb 3;120(3):514–26.
DOI: 10.1161/CIRCRESAHA.116.308407
Yue R, Li D, Yu J, Li S, Ma Y, Huang S, et al. Atrial fibrillation is associated with poor outcomes in thrombolyzed patients with acute ischemic stroke: A systematic review and meta-analysis. Med (United States); 2016. 95(10):1–9.
Caplan LR. Caplan’s Stroke: A Clinical Approach. 5th ed. Philadelphia: Cambridge University Press; 2016. ISBN-13: 978-1107087293. ISBN-10: 1107087295
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American heart association/American stroke association. Stroke; 2013. 44(7):2064–89. Available from: https://www.ahajournals.org/doi/10.1161/str.0b013e318296aeca#pane-pcw-details
Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics - 2021 update: A report from the american heart association. Circulation; 2021. Jan 27;CIR0000000000000950.
Murphy SJ, Werring DJ. Stroke: Causes and clinical features. Med (United Kingdom); 2020. 48(9):561–6. DOI: 10.1016/j.mpmed.2020.06.002
An SJ, Kim TJ, Yoon BW. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: An update. J Stroke; 2017. 19(1):3–10.
DOI: 10.5853/jos.2016.00864
Chiu D, Peterson L, Elkind MSV, Rosand J, Gerber LM, Silverstein MD. Comparison of outcomes after intracerebral hemorrhage and ischemic stroke. J Stroke Cerebrovasc Dis; 2010. 19(3):225–9.
Salvadori E, Papi G, Insalata G, Rinnoci V, Donnini I, Martini M, et al. Comparison between ischemic and hemorrhagic strokes in functional outcome at discharge from an intensive rehabilitation hospital. Diagnostics; 2020. Dec 28;11(1):38.
Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP. Hemorrhagic and ischemic strokes compared: Stroke severity, mortality, and risk factors. Stroke; 2009. 40(6):2068–72.
Paolucci S, Antonucci G, Grasso MG, Bragoni M, Coiro P, De Angelis D, et al. Functional outcome of ischemic and hemorrhagic stroke patients after inpatient rehabilitation: A matched comparison. Stroke; 2003. 34(12):2861–5.
DOI: 10.1161/01.STR.0000102902.39759.D3
Bhalla A, Wang Y, Rudd A, Wolfe CDA. Differences in outcome and predictors between ischemic and intracerebral hemorrhage: The south london stroke register. Stroke; 2013. 44(8):2174–81.
DOI: 10.1161/STROKEAHA.113.001263
Jamilatul Badriyah N, Amalia L, Suwarman S. Gambaran faktor risiko kejadian stroke di RSHS Bandung Periode Januari 2015 - Desember 2016. J Neuroanestesi Indones; 2018. 7(3):134–9. Available from: http://inasnacc.org/ojs2/index.php/jni/article/view/18
Zhuo Y, Wu J, Qu Y, Yu H, Huang X, Zee B, et al. Clinical risk factors associated with recurrence of ischemic stroke within two years. Medicine (Baltimore); 2020. Jun 26;99(26):e20830.
DOI: 10.1097/MD.0000000000020830
Park J-H, Ovbiagele B. Neurologic symptom severity after a recent noncardioembolic stroke and recurrent vascular risk. J Stroke Cerebrovasc Dis; 2015. May;24(5):1032–7.
DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.033
Flach C, Muruet W, Wolfe CDA, Bhalla A, Douiri A. Risk and secondary prevention of stroke recurrence: A population-base cohort study. Stroke; 2020. 51(8):2435–44.
DOI: 10.1161/STROKEAHA.120.028992
Matsuo R, Yamaguchi Y, Matsushita T, Hata J, Kiyuna F, Fukuda K, et al. Association between onset-to-door time and clinical outcomes after ischemic stroke. Stroke; 2017. 48(11):3049–56.
Hedna VS, Bodhit AN, Ansari S, Falchook AD, Stead L, Heilman KM, et al. Hemispheric differences in ischemic stroke: Is left-hemisphere stroke more common? J Clin Neurol; 2013. 9(2):97–102.
DOI: 10.3988/jcn.2013.9.2.97
Young PA, Young PH, Tolbert DL. Basic clinical neuroscience. 3rd ed. Wolters Kluwer. Philadelphia: Wolters Kluwer; 2016. 220–222. ISBN-13: 978-1451173291. ISBN-10: 1451173296
Rathore SS, Hinn AR, Cooper LS, Tyroler HA, Rosamond WD. Characterization of incident stroke signs and symptoms findings from the atherosclerosis risk in communities study. Stroke; 2002. 33(11):2718–21. DOI: 10.1161/01.str.0000035286.87503.31
Sanyasi RDLR, Pinzon RT. Clinical symptoms and risk factors comparison of ischemic and hemorrhagic stroke. J Kedokt dan Kesehat Indones; 2018. 9(1):5–15.
DOI: /10.20885/JKKI.Vol9.Iss1.art3
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Malang Neurology Journal

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.