Clinical prediction models for mortality and functional outcome following ischemic stroke: A systematic review and meta-analysis

Abstract

ObjectiveWe aim to identify and critically appraise clinical prediction models of mortality and function following ischaemic stroke.MethodsElectronic databases, reference lists, citations were searched from inception to September 2015. Studies were selected for inclusion, according to pre-specified criteria and critically appraised by independent, blinded reviewers. The discrimination of the prediction models was measured by the area under the curve receiver operating characteristic curve or c-statistic in random effects meta-analysis. Heterogeneity was measured using I2. Appropriate appraisal tools and reporting guidelines were used in this review.Results31395 references were screened, of which 109 articles were included in the review. These articles described 66 different predictive risk models. Appraisal identified poor methodological quality and a high risk of bias for most models. However, all models precede the development of reporting guidelines for prediction modelling studies. Generalisability of models could be improved, less than half of the included models have been externally validated(n = 27/66). 152 predictors of mortality and 192 predictors and functional outcome were identified. No studies assessing ability to improve patient outcome (model impact studies) were identified.ConclusionsFurther external validation and model impact studies to confirm the utility of existing models in supporting decision-making is required. Existing models have much potential. Those wishing to predict stroke outcome are advised to build on previous work, to update and adapt validated models to their specific contexts opposed to designing new ones.

The Association Between an Antecedent of Transient Ischemic Attack Prior to Onset of Stroke and Functional Ambulatory Outcome

“…Several prognostic measures have been used to predict functional outcomes following thrombolytic therapy in patients with ischemic stroke. [9][10][11][12][13] These measures are based on clinical characteristics of the patient and provide cumulative evaluations for the management of poststroke treatment care. Accurate predictions of ambulatory functions are needed as well, so that clinicians can help patients set motor recovery goals to improve activities of daily living [14][15][16][17][18] following thrombolysis therapy.…”

Neural Stem Cell Extracellular Vesicles Disrupt Midline Shift Predictive Outcomes in Porcine Ischemic Stroke Model

“…There are multiple barriers to clinical translation of effective ischemic stroke therapeutics; one of which is the identification of an MRI-detectable structural parameter that can noninvasively predict functional outcome [14,[53][54][55]. Once identified and validated, these predictive biomarkers could then be utilized to assess clinical efficacy of novel therapeutics through divergence from established functional correlations [52].…”

Development and validation of clinical prediction models for mortality, functional outcome and cognitive impairment after stroke: a study protocol

“…Candidate predictors to be considered in the prediction models will be based on predictor variables as identified in previous systematic reviews in this field, 15 22 ease and reliability of measurement in clinical setting and theoretical association with the progression of outcomes. The number of variables required to ensure adequate power based on our target sample size (see below), to avoid overfitting and to encourage parsimony and applicability of the model in clinical practice will also be considered.…”

“…The systematic review and meta-analysis concluded that existing models have much potential and advised to build on previous work, as opposed to designing new models, in developing CPMs suitable for the long-term care setting. 15 Models predicting outcomes longitudinally, as opposed to predefined time points, may best support patient management and so we will build on work by colleagues in this area. 18 19 …”