Ischemic Stroke demographics, Clinical Features and Scales and Their Correlations: an Exploratory Study From Jordan

Abstract

Aims: The authors aimed to assess the ischemic stroke risk factors and scales. Materials & methods: A retrospective cohort study was conducted on patients with acute ischemic stroke (from January 2017 to December 2018). The scores of the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge and of the modified Rankin Scale (mRS) and Barthel Index (BI) scale post-month of the stroke were collected. Results: Out of 376 patients, 359 were included, with a mean (standard deviation) age of 67.8 (12.2) years and male predominance (56.2%). Hyperlipidemia and hypertension were the most prevalent comorbidities (91.1% and 80.5%, respectively). The NIHSS, BI and mRS scores were worse among women, with no significant effects for comorbidities. The NIHSS scores at admission and discharge were significantly correlated with the post-month BI and mRS scores. Conclusion: The study findings suggest a complex interplay of gender, strict control and prevention of the modifiable stroke risk factors, as well as the association of neurological deficits' intensity with the functional outcomes.

Plain Language Summary

This study aimed to explore the demographics, the clinical risk factors and the scores of the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) scale at different points of time among the survivors of acute ischemic stroke at a tertiary hospital in Jordan. Also, the study aimed to investigate the differences in the scales' scores by the patients' characteristics and the correlations between these scales. Out of 376 screened patients, 359 were included. Their mean (standard deviation) age was 67.8 (12.2) years, and 56.2% were men. Compared with male participants, women scored significantly worse on the NIHSS at admission (7.61 [5.51] vs 9.47 [6.64]; p = 0.048), NIHSS at discharge (5.57 [4.72] vs 7.40 [5.88]; p = 0.028) and BI scale 1 month post-event (78.68 [28.33] vs 66.03 [35.86]; p = 0.011). The mean (standard deviation) mRS score post-month of stroke was lower in men (2.4 [1.7]) than in women (2.9 [1.9]), with a lack of statistical significance (p = 0.097). Thus, despite the male predominance in the cohort, women tended to have a more severe stroke, worse neurological impairment and poorer functional outcomes. Hyperlipidemia had the highest prevalence, sensitivity, positive predictive value and negative predictive value rates, followed by hypertension. No statistically significant differences existed in the comorbidities' NIHSS, BI scale and mRS scores. Strong and significant correlations were observed between the scores of NIHSS at admission and discharge and the BI scale and mRS scores at 1 month post-event. Thus, the authors concluded that neurological deficit severity has a potential role in predicting functioning outcomes and vice versa.

Graphical abstract

Keywords:

• Barthel Index
• BI
• gender
• hyperlipidemia
• hypertension
• ischemic stroke
• modified Rankin Scale
• mRS
• NIHSS
• risk factors
• stroke

Author contributions

KZ Alawneh and AH Al-Mistarehi made substantial contributions to the conceptualization, design of the work, supervision, methodology, acquisition, validation, formal analysis, investigation, writing and editing of the manuscript and critical review for important intellectual content. M Al Qawasmeh and LA Raffee substantially contributed to this study by designing the work, acquisition, data collection, data curation, interpretation of data, visualization, validation, project administration, writing of the original draft of the manuscript and review of the manuscript. All authors have read and agreed to the final published version of the manuscript. All authors have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved.

Acknowledgments

The authors are very thankful to all the associated personnel in any reference that contributed to this research.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

All procedures performed in this study involving human participants were reviewed and ethically approved by the Institutional Review Board at Jordan University of Science and Technology, Irbid, Jordan (IRB number: 279/2019). This study was conducted following the 1975 Helsinki Declaration, revised in 2008, and its later amendments or comparable ethical standards. The informed consent from the study participants was waived due to the retrospective design of the study. Data related to each participant were de-identified, as a particular code was generated for each patient. Also, the file containing the link of the patient-specific code with the patient's hospital file number was locked and password protected, and the data analysis was conducted on the de-identified file. This work has been reported as an observational study based on Strengthening the Reporting of Observational Studies in Epidemiology 2019 guidelines [34].

Data sharing statement

The datasets generated and analyzed during the current study are available from the corresponding authors upon reasonable request ([email protected]; [email protected]).