{
  "abstract": "Background: Stroke outcomes are commonly assessed using the modified Rankin Scale (mRS), dichotomized into “favorable” (0–2) and “unfavorable” (3–6). Many elderly patients present with pre-stroke mRS scores of 3–5, making “favorable” outcomes unattainable and complicating treatment evaluation.\n\nMethods: This is a monocentric, retrospective analysis of ischemic stroke patients in our prospective registry (2010–2022). Outcomes include mRS scores at discharge and 90 days post-stroke. Descriptive and inferential statistics were applied with appropriate tests for categorical and ordinal variables. Multivariable logistic regression was used to model return to pre-stroke mRS and death by 90 days, adjusted for pre-stroke mRS group, age, sex, NIHSS on admission, treatment modality and vascular territory. Statistical significance was defined as p < 0.05.\n\nResults: Of 3,724 ischemic stroke patients admitted, 2,070 met inclusion criteria (median age 75.7). Among those with favorable pre-stroke mRS (0–2, n = 1,827), 47.6% achieved favorable outcomes at discharge and 47.5% at 90 days. By definition, none with unfavorable pre-stroke mRS achieved favorable outcomes. At discharge, return to baseline mRS occurred in 16.2% with favorable pre-stroke mRS, compared to 19.3% with unfavorable ( p = 0.216). 90 days post-stroke, return to baseline occurred in 21.8% with favorable pre-stroke mRS, compared to 11.9% with unfavorable ( p < 0.001). Redefining favorable outcome to include return to pre-stroke mRS increased rates from 42.0 to 44.3% at discharge and from 41.9 to 43.3% 90 days post-stroke ( p < 0.001). In multivariable analysis a pre-stroke mRS of 3–5 was associated with death by 90 days (OR 4.40, 95% CI 3.18–6.10) but not with return to baseline in all patients (OR 1.02, 95% CI 0.65–1.58); among survivors it was associated with a higher probability of return to baseline (OR 2.34, 95% CI 1.40–3.91).\n\nConclusion: The traditional dichotomization of mRS does not reflect the wide range of pre-stroke status. Incorporating “return to pre-stroke mRS score” as a favorable outcome metric alongside the conventional dichotomy provides a more individualized measure, improving treatment evaluation and supporting tailored care strategies, particularly for patients with higher pre-stroke mRS scores.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen",
    "Department of Neurology, University Hospital RWTH Aachen",
    "Department of Neuroradiology, University Hospital Bielefeld"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Julia-Laura Schulz"
    },
    {
      "affs": [
        1
      ],
      "name": "Arno Reich"
    },
    {
      "affs": [
        0
      ],
      "name": "Charlotte S. Weyland"
    },
    {
      "affs": [
        0
      ],
      "name": "Hani Ridwan"
    },
    {
      "affs": [
        0
      ],
      "name": "Dimah Hasan"
    },
    {
      "affs": [
        0
      ],
      "name": "Rebecca May"
    },
    {
      "affs": [
        0
      ],
      "name": "Martin Wiesmann"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Omid Nikoubashman"
    },
    {
      "affs": [
        1
      ],
      "name": "João Pinho"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4qscx6hqbcaan.bib",
  "cited_by": 0,
  "doi": "10.3389/fneur.2026.1866829",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724383/?tool=EBI",
  "id": "4qscx6hqbcaan",
  "issns": [
    "1664-2295"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1866829/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2713|Acute Ischemic Stroke Management"
    ]
  ],
  "openalex": "W7222942667",
  "pdf_url": "https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2026.1866829/pdf",
  "pmcid": "PMC13724383",
  "pmid": "42973595",
  "published": "2026-10-19",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/4qscx6hqbcaan.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:16Z",
      "native_id": "10.3389/fneur.2026.1866829",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1866829/full"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Acute Ischemic Stroke Management",
      "subfield": "epidemiology-public-health"
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  ],
  "title": "Rethinking favorable outcomes: “return to baseline” as an additional outcome in ischemic stroke",
  "title_text": "Rethinking favorable outcomes: “return to baseline” as an additional outcome in ischemic stroke",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:20:53Z",
  "url": "https://research.draconitic.com/paper/4qscx6hqbcaan",
  "venue": "Frontiers in Neurology",
  "versions": []
}