STUDY OF STROKE SEVERITY (NIHSS SCORE) AND SHORT-TERM OUTCOME- A TERTIARY CARE CENTER EXPERIENCE

Abstract

Background: Stroke remains a leading cause of mortality and long-term disability worldwide. The National Institutes of Health Stroke Scale (NIHSS) is widely used to quantify neurological impairment at presentation, yet its prognostic value in real-world clinical settings requires ongoing validation. This study aimed to evaluate the relationship between admission NIHSS scores and short-term outcomes, including in-hospital mortality, length of stay, and 30-day functional status.

Methods: A prospective observational study was conducted over 6 months in the Department of Neurology/Medicine of a tertiary care teaching hospital. Two hundred consecutive patients with acute stroke (ischemic or hemorrhagic) presenting within 7 days of symptom onset were enrolled. Baseline NIHSS scores were recorded at admission and categorized as mild (0–5), moderate (6–14), or severe (≥15). Primary outcomes included in-hospital mortality, complications, length of stay, and 30-day functional outcome assessed by the modified Rankin Scale (mRS). Logistic regression analysis identified independent predictors of unfavorable outcome (mRS 3–6).

Results: The mean age was 61.8±12.4 years with 62% male predominance. Hypertension (71%) and diabetes mellitus (39%) were the most prevalent risk factors. Ischemic stroke accounted for 76% of cases. The mean baseline NIHSS score was 9.1±5.8. In-hospital mortality increased progressively from 2.9% in mild strokes to 39.1% in severe strokes. At 30 days, favorable functional outcome (mRS 0–2) was achieved in 79.4% of mild, 46.5% of moderate, and only 13.0% of severe stroke patients. Multivariate analysis revealed that each one-point increase in baseline NIHSS independently raised the odds of unfavorable 30-day outcome by 15% (adjusted OR 1.15, 95% CI 1.08–1.23, p<0.001). Hemorrhagic stroke (adjusted OR 2.05, 95% CI 1.02–4.10, p=0.044) and advancing age (adjusted OR 1.28 per decade, 95% CI 1.06–1.55, p=0.009) were also independent predictors of poor outcome.

Conclusion: Baseline NIHSS score is a powerful, independent predictor of both acute in-hospital outcomes and 30-day functional recovery following stroke. A clear dose-response relationship exists between initial stroke severity and mortality, with each one-point NIHSS increase conferring 15% higher odds of unfavorable outcome. These findings support the systematic use of NIHSS for clinical triaging, resource allocation, prognostication, and family counseling. The high prevalence of delayed hospital presentation (only 27% within 3 hours) underscores the urgent need for enhanced public awareness and primary prevention strategies.