Table 1_Diagnostic performance of the expanded National Institutes of Health Stroke Scale for the assessment of anterior and posterior circulation strokes.docx

The mean e-NIHSS score was higher than the mean classical NIHSS score (p < 0.001). An unfavourable outcome at 3 months was detected in 113 (45%) patients. The e-NIHSS showed a discriminative performance to predict unfavorable functional outcome comparable to the classical NIHSS for the total amount of strokes (AUC-ROC of the e-NIHSS for the first observer, 0.867 [95% CI, 0.823–0.911]; AUC-ROC of the e-NIHSS for the second observer, 0.871 [95% CI, 0.827–0.914]; AUC-ROC of the classical NIHSS, 0.849 [95% CI, 0.802–0.897]), AC strokes (AUC-ROC of the e-NIHSS for the first observer, 0.886 [95% CI, 0.841–0.932]; AUC-ROC of the e-NIHSS for the second observer, 0.892 [95% CI, 0.848–0.936]; AUC-ROC of the classical NIHSS, 0.870 [95% CI, 0.821–0.920]), and PC strokes (AUC-ROC of the e-NIHSS for the first observer, 0.800 [95% CI, 0.685–0.916]; AUC-ROC of the e-NIHSS for the second observer, 0.791 [95% CI, 0.672–0.910]; AUC-ROC of the classical NIHSS, 0.804 [95% CI, 0.689–0.920]).

Net reclassification improvement, integrated discrimination improvement, and decision curve analysis showed a modest apparent incremental prognostic benefit of the e-NIHSS over the classical NIHSS in the whole cohort and in AC strokes, but not in PC strokes.</p>Conclusion<p>Compared to the classical NIHSS, the e-NIHSS showed a similar discriminative performance to predict 3-month functional outcome, capturing and quantifying additional PC-relevant clinical signs not fully represented in the classical NIHSS, with excellent inter-rater reliability.</p>