 |
|
Factor Analysis of the National Institutes of Health Stroke Scale in Patients With Large Strokes
Patrick Lyden, MD;
Lennart Claesson, PhD;
Suzanne Havstad, PhD;
Tim Ashwood, PhD;
Mei Lu, PhD
Arch Neurol. 2004;61:1677-1680.
Background The National Institutes of Health Stroke Scale (NIHSS) was created to detect treatment-related differences in clinical trials and was designed to measure right- and left-sided cerebral hemispheric function.
Objective To validate the original design in patients with very large strokes.
Design A previously published factor structure was fit to the data. Then, a new analysis was conducted to explore the underlying structure of the scale in this population. Finally, NIHSS scores and infarction volumes were compared.
Setting The Clomethiazole for Acute Stroke Study–Ischemic, conducted in academic and community hospitals.
Patients Individuals with acute stroke seen within 12 hours of onset. Of 1191 records available, 98% had complete NIHSS scores.
Main Outcome Measure Goodness-of-fit statistic (Bentler) for each factor solution.
Results Two factors were found underlying the NIHSS, corresponding to the left and right hemispheres (goodness of fit = 0.97), using the previously published factor analysis. The new exploratory analysis also suggested 2 factors representing left and right brain function. The median (range) NIHSS scores were 15 (5-25) for right brain strokes and 19 (6-32) for left brain strokes (P<.001). The median (range) infarction volumes were 56.2 mL (0.1-381.5 mL) for right brain strokes and 37.8 mL (0.2-255.1 mL) for left brain strokes (P<.001). The correlation coefficient between NIHSS score and lesion volume was 0.37 (P<.001).
Conclusions The underlying structure of the NIHSS conforms to cerebral hemispheric lateralization, confirming previous findings in a new population of large hemispheric strokes. Left- brain strokes score 4 points higher on the NIHSS than right brain strokes of larger volume.
Author Affiliations: Department of Neurology, Veterans Administration Medical Center, San Diego, Calif (Dr Lyden); Department of Neurosciences, University of California San Diego School of Medicine (Dr Lyden); AstraZeneca LLP, Södertälje, Sweden (Drs Claesson and Ashwood); and Department of Biostatistics and Research Epidemiology, Henry Ford Health Science Center, Detroit, Mich (Drs Havstad and Lu).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
The Cost of Pediatric Stroke Care and Rehabilitation
Lo et al.
Stroke 2008;39:161-165.
ABSTRACT
| FULL TEXT
The Real Estate Factor: Quantifying the Impact of Infarct Location on Stroke Severity
Menezes et al.
Stroke 2007;38:194-197.
ABSTRACT
| FULL TEXT
Neglecting the Difference: Does Right or Left Matter in Stroke Outcome After Thrombolysis?
Legge et al.
Stroke 2006;37:2066-2069.
ABSTRACT
| FULL TEXT
The impact of lesion side on acute stroke treatment
Di Legge et al.
Neurology 2005;65:81-86.
ABSTRACT
| FULL TEXT
|
