Table 3.
The characteristics of the patient population utilized in NIHSS shift prediction.
| Variables | High NIHSS Shift | Low NIHSS Shift | p Values | Total | |
|---|---|---|---|---|---|
| Mean (± SD), Median (IQR), or n (%) | Mean (± SD), Median (IQR), or n (%) | Mean (± SD), Median (IQR), or n (%) | |||
| Age | 66.0 (17.0) | 66.27 (± 15.16) | 0.897 | 67.0 (19.25) | |
| Sex | Female | 53 (59.6%) | 55 (55.6%) | 0.685 | 108 (57.4%) |
| Male | 36 (40.4%) | 44 (44.4%) | 80 (42.6%) | ||
| Race | White | 43 (48.3%) | 48 (48.5%) | 0.985 | 91 (48.4%) |
| Black/African American | 41 (46.1%) | 46 (46.5%) | 87 (46.3%) | ||
| Other | 5 (5.6%) | 5 (5.0%) | 10 (5.3%) | ||
| Alcohol | Not current alcohol user | 64 (71.9%) | 67 (67.7%) | 0.637 | 131 (69.7%) |
| Current alcohol user | 25 (28.1%) | 32 (32.3%) | 57 (30.3%) | ||
| Smoking | Never smoker | 57 (64.0%) | 45 (45.4%) | 0.016 | 102 (54.3%) |
| Current or former smoker | 32 (36.0%) | 54 (54.6%) | 86 (45.7%) | ||
| Was Johns Hopkins the initial hospital? | No, transferred to JHH | 16 (18.0%) | 32 (32.3%) | 0.037 | 48 (25.5%) |
| Yes | 73 (82.0%) | 67 (67.7%) | 140 (74.5%) | ||
| Hypertension | No | 17 (19.1%) | 25 (25.2%) | 0.403 | 42 (22.3%) |
| Yes | 72 (80.9%) | 74 (74.8%) | 146 (77.7%) | ||
| Diabetes | No | 69 (77.5%) | 68 (68.7%) | 0.231 | 137 (72.9%) |
| Yes | 20 (22.5%) | 31 (31.3%) | 51 (27.1%) | ||
| Atrial fibrillation | No | 53 (59.6%) | 66 (66.7%) | 0.39 | 119 (63.3%) |
| Yes | 36 (40.4%) | 33 (33.3%) | 69 (36.7%) | ||
| Heart disease | No | 40 (44.9%) | 58 (58.6%) | 0.085 | 98 (52.1%) |
| Yes | 49 (55.1%) | 41 (41.4%) | 90 (47.9%) | ||
| Dyslipidemia | No | 51 (57.3%) | 48 (48.5%) | 0.288 | 99 (52.7%) |
| Yes | 38 (42.7%) | 51 (51.5%) | 89 (47.3%) | ||
| Chronic kidney disease | No | 70 (78.6%) | 81 (81.8%) | 0.718 | 151 (80.3%) |
| Yes | 19 (21.4%) | 18 (18.2%) | 37 (19.7%) | ||
| Deep vein thrombosis/Pulmonary embolism | No | 78 (87.6%) | 88 (88.9%) | 0.969 | 166 (88.3%) |
| Yes | 11 (12.4%) | 11 (11.1%) | 22 (11.7%) | ||
| Hepatitis C virus | No | 84 (94.4%) | 95 (96.0%) | 0.87 | 179 (95.2%) |
| Yes | 5 (5.6%) | 4 (4.0%) | 9 (4.8%) | ||
| Human immunodeficiency virus | No | 88 (98.9%) | 96 (97.0%) | 0.69 | 184 (97.9%) |
| Yes | 1 (1.1%) | 3 (3.0%) | 4 (2.1%) | ||
| Sleep apnea | No | 82 (92.1%) | 87 (87.9%) | 0.469 | 169 (89.9%) |
| Yes | 7 (7.9%) | 12 (12.1%) | 19 (10.1%) | ||
| Prior stroke/TIA | No | 66 (74.2%) | 81 (81.8%) | 0.274 | 147 (78.2%) |
| Yes | 23 (25.8%) | 18 (18.2%) | 41 (21.8%) | ||
| Peripheral vascular disease | No | 85 (95.5%) | 91 (91.9%) | 0.48 | 176 (93.6%) |
| Yes | 4 (4.5%) | 8 (8.1%) | 12 (6.4%) | ||
| Obesity | No | 61 (68.5%) | 63 (63.6%) | 0.579 | 124 (66.0%) |
| Yes | 28 (31.5%) | 36 (36.4%) | 64 (34.0%) | ||
| History of malignancy | No | 75 (84.3%) | 79 (79.8%) | 0.545 | 154 (81.9%) |
| Yes | 14 (15.7%) | 20 (20.2%) | 34 (18.1%) | ||
| Antiplatelet or anticoagulation use | No | 48 (53.9%) | 65 (65.7%) | 0.136 | 113 (60.1%) |
| Yes | 41 (46.1%) | 34 (34.3%) | 75 (39.9%) | ||
| Admission BMI | 27.37 (7.11) | 29.01 (9.08) | 0.293 | 28.47 (7.53) | |
| Admission HR | 82.0 (25.0) | 82.0 (25.5) | 0.519 | 82.0 (26.0) | |
| Admission SBP | 150.47 (± 25.54) | 147.0 (43.5) | 0.57 | 147.0 (32.25) | |
| Admission DBP | 81.0 (22.0) | 88.75 (± 19.67) | 0.199 | 85.0 (27.0) | |
| Admission RR | 18.0 (4.0) | 18.0 (4.0) | 0.112 | 18.0 (4.0) | |
| Admission SpO2 | 98.0 (3.0) | 98.0 (2.0) | 0.441 | 98.0 (3.0) | |
| Admission SI | 0.56 (0.21) | 0.56 (0.18) | 0.989 | 0.56 (0.18) | |
| Age related admission SI | 36.4 (13.82) | 35.38 (15.38) | 0.913 | 36.12 (14.92) | |
| Admission sodium | 138.87 (± 3.4) | 139.02 (± 3.39) | 0.77 | 139.0 (4.0) | |
| Admission potassium | 4.12 (± 0.4) | 4.1 (0.55) | 0.935 | 4.1 (0.6) | |
| Admission glucose | 116.0 (40.0) | 114.0 (36.0) | 0.558 | 116.0 (38.0) | |
| Admission calcium | 8.92 (± 0.58) | 9.1 (0.8) | 0.058 | 9.0 (0.73) | |
| Admission BUN | 16.0 (8.0) | 16.0 (7.0) | 0.726 | 16.0 (7.0) | |
| Admission creatinine | 1.0 (0.43) | 0.9 (0.4) | 0.294 | 0.98 (0.4) | |
| Admission hematocrit | 39.63 (± 5.07) | 40.12 (± 5.49) | 0.528 | 39.89 (± 5.29) | |
| Admission hemoglobin | 12.83 (± 1.75) | 13.01 (± 1.97) | 0.519 | 12.93 (± 1.86) | |
| Admission WBC count | 8.02 (3.37) | 7.9 (4.02) | 0.721 | 8.01 (3.55) | |
| Admission platelet count (×1000) | 219.0 (100.0) | 232.0 (104.2) | 0.039 | 225.5 (97.0) | |
| Admission platelet count (×1000) to WBC count ratio | 28.45 (13.12) | 28.97 (12.6) | 0.073 | 28.78 (12.42) | |
| Admission NIHSS | 17.0 (7.0) | 9.0 (12.0) | <0.001 | 14.0 (11.0) | |
| Door to CT (minutes) | 25.0 (26.0) | 26.0 (28.0) | 0.214 | 25.0 (28.25) | |
| Baseline non-contrast CT ASPECTS on 5-mm cuts | 9.0 (2.0) | 10.0 (2.0) | 0.603 | 9.0 (2.0) | |
| Hyperdense MCA present on thin cuts? | No | 31 (34.8%) | 52 (52.5%) | 0.022 | 83 (44.2%) |
| Yes | 58 (65.2%) | 47 (47.5%) | 105 (55.8%) | ||
| Stroke etiology (TOAST criteria) | Cardioembolism | 50 (56.2%) | 46 (46.5%) | 0.2 | 96 (51.1%) |
| Large artery atherosclerosis | 11 (12.4%) | 24 (24.2%) | 35 (18.6%) | ||
| Stroke of undetermined etiology | 21 (23.6%) | 23 (23.2%) | 44 (23.4%) | ||
| Stroke of other determined etiology | 7 (7.9%) | 6 (6.1%) | 13 (6.9%) | ||
| Laterality | Left | 44 (49.4%) | 50 (50.5%) | 0.622 | 94 (50.0%) |
| Right | 45 (50.6%) | 48 (48.5%) | 93 (49.5%) | ||
| Bilateral | 0 (0.0%) | 1 (1.0%) | 1 (0.5%) | ||
| Occluded segment | M1 | 44 (49.4%) | 52 (52.5%) | 0.833 | 96 (51.1%) |
| M2 | 20 (22.5%) | 23 (23.2%) | 43 (22.9%) | ||
| M1 and M2 | 25 (28.1%) | 24 (24.2%) | 49 (26.1%) | ||
| Hemorrhagic transformation? | No | 54 (60.7%) | 69 (69.7%) | 0.252 | 123 (65.4%) |
| Yes | 35 (39.3%) | 30 (30.3%) | 65 (34.6%) | ||
| Type of hemorrhagic transformation | None | 54 (60.7%) | 69 (69.7%) | 0.213 | 123 (65.4%) |
| HI1 | 3 (3.4%) | 4 (4.0%) | 7 (3.7%) | ||
| HI2 | 14 (15.7%) | 18 (18.2%) | 32 (17.0%) | ||
| PH1 | 14 (15.7%) | 6 (6.1%) | 20 (10.6%) | ||
| PH2 | 4 (4.5%) | 2 (2.0%) | 6 (3.2%) | ||
| Calculated rCBF 20% volume (mL) | 0.0 (7.0) | 0.0 (8.3) | 0.479 | 0.0 (8.0) | |
| Calculated rCBF 30% volume (mL) | 9.2 (25.0) | 8.0 (25.3) | 0.911 | 8.6 (25.0) | |
| Calculated rCBF 34% volume (mL) | 18.0 (35.4) | 13.8 (31.4) | 0.684 | 14.7 (33.25) | |
| Calculated rCBF 38% volume (mL) | 23.4 (40.0) | 20.6 (32.5) | 0.53 | 21.5 (38.1) | |
| Calculated Tmax 4 s volume (mL) | 206.8 (105.4) | 193.0 (130.1) | 0.212 | 197.4 (129.2) | |
| Calculated Tmax 6 s volume (mL) | 116.49 (± 58.85) | 90.0 (75.5) | 0.028 | 102.5 (82.25) | |
| Calculated Tmax 8 s volume (mL) | 75.33 (± 45.75) | 51.0 (62.4) | 0.013 | 62.1 (66.0) | |
| Calculated Tmax 10 s volume (mL) | 45.0 (57.8) | 33.8 (49.0) | 0.047 | 39.2 (57.4) | |
| CBV 34% (mL) | 3.0 (15.0) | 3.0 (16.5) | 0.787 | 3.0 (15.25) | |
| CBV 38% (mL) | 5.0 (17.0) | 5.0 (18.4) | 0.897 | 5.0 (18.0) | |
| CBV 42% (mL) | 5.4 (19.4) | 6.0 (21.0) | 0.939 | 6.0 (21.0) | |
| Calculated mismatch (mL) | 94.0 (65.0) | 78.0 (79.5) | 0.016 | 83.8 (66.25) | |
| Calculated mismatch ratio | 16.8 (35.9) | 18.14 (35.21) | 0.992 | 17.84 (35.72) | |
| Hypoperfusion index | 0.4 (0.4) | 0.3 (0.2) | 0.035 | 0.33 (0.3) | |
| Single phase CTA collateral score | 2.0 (1.0) | 2.0 (1.0) | 0.749 | 2.0 (1.0) | |
| DSA collaterals (ASITN/SIR criteria) | 2.0 (1.0) | 3.0 (1.5) | 0.039 | 2.0 (1.05) | |
| Clot burden score | 6.0 (3.0) | 6.2 (2.0) | 0.383 | 6.0 (2.85) | |
| IV TPA administered? | No | 58 (65.2%) | 73 (73.7%) | 0.264 | 131 (69.7%) |
| Yes | 31 (34.8%) | 26 (26.3%) | 57 (30.3%) | ||
| Door to needle time (minutes) | 1113.0 (1050.0) | 1113.0 (946.0) | 0.144 | 1113.0 (1031.0) | |
| MT attempted? | No | 6 (6.7%) | 35 (35.4%) | <0.001 | 41 (21.8%) |
| Yes | 83 (93.3%) | 64 (64.6%) | 147 (78.2%) | ||
| Type of anesthesia | General | 76 (85.4%) | 59 (59.6%) | <0.001 | 135 (71.8%) |
| Monitored anesthesia care | 7 (7.9%) | 5 (5.0%) | 12 (6.4%) | ||
| MT not attempted | 6 (6.7%) | 35 (35.4%) | 41 (21.8%) | ||
| Door to groin puncture (minutes) | 139.0 (88.0) | 236.0 (1399.0) | <0.001 | 174.0 (346.25) | |
| Groin puncture to recanalization (minutes) | 32.0 (31.0) | 60.0 (155.0) | <0.001 | 39.5 (73.35) | |
| Door to recanalization (minutes) | 180.0 (120.0) | 292.0 (1429.5) | <0.001 | 209.0 (367.5) | |
| Number of Passes | 1 | 62 (69.7%) | 37 (37.4%) | <0.001 | 99 (52.7%) |
| 2 | 14 (15.7%) | 11 (11.1%) | 25 (13.3%) | ||
| 3 | 5 (5.6%) | 7 (7.1%) | 12 (6.4%) | ||
| 4 | 1 (1.1%) | 6 (6.1%) | 7 (3.7%) | ||
| 5 | 1 (1.1%) | 3 (3.0%) | 4 (2.1%) | ||
| MT not attempted | 6 (6.7%) | 35 (35.4%) | 41 (21.8%) | ||
| mTICI | 0 | 0 (0.0%) | 6 (6.1%) | <0.001 | 6 (3.2%) |
| 1 | 2 (2.2%) | 2 (2.0%) | 4 (2.1%) | ||
| 2a | 2 (2.2%) | 5 (5.0%) | 7 (3.7%) | ||
| 2b | 21 (23.6%) | 14 (14.1%) | 35 (18.6%) | ||
| 2c | 9 (10.1%) | 7 (7.1%) | 16 (8.5%) | ||
| 3 | 49 (55.1%) | 30 (30.3%) | 79 (42.0%) | ||
| MT not attempted | 6 (6.7%) | 35 (35.4%) | 41 (21.8%) | ||
| Discharge sodiuma | 139.3 (± 2.8) | 139.0 (4.0) | 0.841 | 139.0 (4.0) | |
| Discharge potassium a | 4.14 (± 0.39) | 4.26 (± 0.42) | 0.048 | 4.2 (± 0.41) | |
| Discharge glucose a | 103.0 (25.0) | 107.0 (29.5) | 0.155 | 104.1 (25.25) | |
| Discharge calcium a | 8.77 (± 0.54) | 8.9 (0.7) | 0.092 | 8.86 (0.7) | |
| Discharge BUN a | 15.6 (7.0) | 16.0 (9.5) | 0.262 | 15.8 (8.0) | |
| Discharge creatinine a | 0.9 (0.45) | 0.84 (0.4) | 0.318 | 0.9 (0.4) | |
| Discharge hematocrit a | 35.16 (± 5.63) | 35.62 (± 6.0) | 0.592 | 35.4 (± 5.82) | |
| Discharge hemoglobin a | 11.31 (± 1.97) | 11.47 (± 2.1) | 0.59 | 11.4 (± 2.04) | |
| Discharge WBC count a | 7.91 (2.85) | 8.02 (3.48) | 0.978 | 8.01 (3.16) | |
| Discharge platelet count (×1000) a | 228.0 (115.0) | 254.0 (137.5) | 0.055 | 239.0 (126.75) | |
| Discharge platelet count (×1000) to WBC count ratio a | 29.14 (13.4) | 31.92 (17.84) | 0.08 | 31.06 (16.11) | |
| Discharge BMI a | 26.6 (7.99) | 29.15 (± 7.61) | 0.112 | 27.1 (9.33) | |
| Discharge HR a | 76.0 (27.0) | 76.0 (20.5) | 0.872 | 76.0 (25.0) | |
| Discharge SBP a | 127.22 (± 19.32) | 131.0 (34.5) | 0.044 | 128.5 (27.25) | |
| Discharge DBP a | 68.0 (17.0) | 73.01 (± 13.4) | 0.092 | 70.0 (17.5) | |
| Discharge RR a | 18.0 (2.0) | 18.0 (2.0) | 0.127 | 18.0 (2.0) | |
| Discharge SpO2 a | 97.0 (3.0) | 98.0 (3.0) | 0.647 | 97.0 (3.0) | |
| Discharge NIHSS a | 2.0 (6.0) | 7.0 (13.0) | <0.001 | 4.0 (9.25) | |
| NIHSS shift a | 11.0 (5.0) | 3.0 (5.0) | <0.001 | 7.04 (± 7.12) | |
| 90-day mRS a | 2.0 (2.0) | 2.2 (3.0) | 0.046 | 2.0 (2.0) | |
a Not included as an input in the model. Abbreviations: NIHSS: National Institutes of Health Stroke Scale; SD: Standard deviation; IQR: Interquartile range; JHU: Johns Hopkins Hospitals; TIA: Transient ischemic attack; BMI: Body mass index; HR: Heart rate; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; RR: Respiratory rate; SI: Shock index; BUN: Blood urea nitrogen; WBC: White blood cell; CT: Computed tomography; ASPECTS: Alberta Stroke Program Early CT Score; MCA: Middle cerebral artery; HI: Hemorrhagic infarction; PH: Parenchymal hematoma; rCBF: Relative cerebral blood flow; Tmax: Time to the maximum of the residue function; CBV: Cerebral blood volume; CTA: Computed tomography angiography; DSA: Digital subtraction angiography; ASITN/SIR: The American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology; IV: Intravenous; tPA: Tissue plasminogen activator; MT: Mechanical thrombectomy; mTICI: Modified treatment in cerebral ischemia; mRS: Modified Rankin Score.