OBJECTIVES: Assess value of admission stroke severity in predicting outcomes at discharge for patients with first-ever ischemic stroke in Taiwan. METHODS: Data was prospectively collected from 360 first-ever ischemic stroke patients consecutively admitted to a medical center. Stroke severity was evaluated with NIH stroke scale (NIHSS) and categorized as mild (0-6), moderate (7-15), or severe (16-38). Functional independence status was accessed by modified Barthel Index (MBI) on a scale of 0 - 20. We studied three discharge outcomes: 1) status based on combined measure of neurological impairment and disability (excellent, good, improved, poor); 2) neurologic changes (better, stationary, worse); and 3) functional changes (better, stationary, worse). For each outcome, a separate polytomous logistic regression model with least favorable category as the reference group was constructed, controlling confounding factors. RESULTS: Patients (58% male) had mean age 64.9±12.7 (range 18-93), median NIHSS 6 and median MBI 12 on admission. Median length-of-stay was 7 (range, 1-122) days; in-hospital deaths 8%. Twenty-two percent (22%) of patients were excellent status (NIHSS ≤1 and MBI ≥19), 33% good (NIHSS ≤6 and MBI ≥12 but not excellent). Twenty-two percent (22%) of patients had better neurologic change (decrease on NIHSS ≥4), 61% stationary (NIHSS changed within ±3); functional change, 14% better (MBI changed from < 12 to ≥12), 75% stationary (MBI remained < 12 or ≥12). The odds ratio (OR) for moderate and severe (versus mild) stroke patients to achieve excellent status were 0.04 (95% CI, 0.02-0.10) and <0.01, respectively. The OR for moderate stroke patients to have good or improved outcome was 0.19 (0.10-0.36), for severe stroke 0.04 (0.01-0.13). The OR for moderate and severe (versus mild) stroke patients to have better neurologic change were 5.18 (1.94-13.85) and 4.12 (1.38-12.30), respectively. CONCLUSIONS: Admission NIHSS is predictive of clinical outcomes of acute hospitalization after first-ever ischemic stroke.