Stroke remains a major cause of morbidity and mortality worldwide. In Indonesia, it is the second most commonly diagnosed disease with a significant public health burden. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a well-established clinical tool for assessing early ischemic changes. Lower ASPECTS (≤7) is associated with poorer clinical outcomes and a higher complication risk, particularly following thrombolytic therapy. The 24-h National Institutes of Health Stroke Scale (NIHSS24) score is a standardized measure of stroke severity and early neurological outcomes and strong predictor of long-term functional recovery. This retrospective study included 94 patients with acute ischemic stroke who underwent noncontrast brain computed tomography imaging and NIHSS evaluation at Cipto Mangunkusumo Hospital. Deep learning-based ASPECTS calculation was implemented to enhance accuracy. Associations of clinical, laboratory, and imaging parameters with the NIHSS24 score were evaluated. Linear multivariate and nonlinear regression (quadratic, cubic, and exponential) were performed, with Bonferroni and false detection rate (FDR) corrections for multiple comparisons. Left-hemisphere ASPECTS robustly and independently predicted the NIHSS24 score in linear and nonlinear models. The nonlinear analysis demonstrated a ceiling effect: Patients with higher ASPECTS experienced disproportionately greater improvements in the NIHSS24 score (−1.18 points per ASPECTS point lost), whereas those with lower ASPECTS presented only minimal change (−0.06 points). Patient age exhibited borderline significance in the unadjusted model ( P = 0.0484) but was non-significant after Bonferroni ( P = 0.3872) and FDR corrections ( P = 0.1936). No other clinical or laboratory variables independently predicted the outcomes. Although patients with high ASPECTS had better NIHSS24 scores, these differences were not significant after adjustment. Lower ASPECTS, particularly in the left hemisphere, predicted greater neurological impairment 24-h post-stroke. The nonlinear association indicated nonuniform prognostic sensitivity across the ASPECTS spectrum, with patients with near-normal scores benefiting more from prompt intervention, compared with those with low scores.
Eddy et al. (Sun,) studied this question.