The Stroke Prognosis Instrument II (SPI-II)

Abstract

Background and Purpose-In 1991 we developed the Stroke Prognosis Instrument (SPI-I) to stratify patients with transient ischemic attack or ischemic stroke by prognosis for stroke or death in 2 years. In this article we validate and improve SPI-I (creating SPI-II). Methods-To validate SPI-I, we applied it to 4 test cohorts and calculated pooled outcome rates. To create SPI-II, we incorporated new predictive variables identified in 1 of the test cohorts and validated it in the other 3 cohorts. Results-For SPI-I, pooled rates (all 4 test cohorts) of stroke or death within 2 years in risk groups I, II, and III were 9%, 17%, and 24%, respectively (PϽ0.01, log-rank test). SPI-II was created by adding congestive heart failure and prior stroke to SPI-I. Each patient's risk group was determined by the total score for 7 factors: congestive heart failure (3 points); diabetes (3 points); prior stroke (3 points); age Ͼ70 years (2 points); stroke for the index event (not transient ischemic attack) (2 points); hypertension (1 point); and coronary artery disease (1 point). Risk groups I, II, and III comprised patients with 0 to 3, 4 to 7, and 8 to 15 points, respectively. For SPI-I, pooled rates (3 cohorts excluding the SPI-II development cohort) of stroke or death within 2 years in risk groups I, II, and III were 9%, 17%, and 23%, respectively. For SPI-II, pooled rates were 10%, 19%, and 31%, respectively. In receiver operator characteristic analysis, the area under the curve was 0.59 (95% CI, 0.57 to 0.60) for SPI-I and 0.63 (95% CI, 0.62 to 0.65) for SPI-II, confirming the better performance of the latter. Conclusions-Compared

Predicting Functional Outcome and Symptomatic Intracranial Hemorrhage in Patients With Acute Ischemic Stroke

“…It would be interesting to see whether oxygen administration would still remain an independent covariate if a comorbidity index (eg, Charlson 40 or Elixhauser indexes 41 ) was included in the model. This could possibly be also the case for other comorbidities included in some scores like cancer, 8,9 dementia, 9 renal dialysis, 9 atrial fibrillation, [8][9][10] coronary artery disease, 9,10,42 chronic heart failure, 8,9,42 diabetes mellitus, [9][10][11][12]42 hypertension, 42 smoking habit, 9 and dyslipidemia 10,43 or a more general approach of the prestroke functional status. 5,8,9 In 3 scores, 9,10,13 sex is among their constituents.…”

A score to predict early risk of recurrence after ischemic stroke

“…There is currently no robust prognostic tool for predicting the short-term risk of recurrent stroke. Available prognostic models such as the Stroke Prognosis Instrument II 12 and The Essen Stroke Risk Score 13 are designed to predict the long-term risk and have not been validated for short-term risk prediction. Our goal was to develop a predictive score based on information typically available to the physician at the time of hospital admission to estimate the 90-day risk of recurrent stroke.…”

Validation of the Stroke Prognostic Instrument-II in a Large, Modern, Community-Based Cohort of Ischemic Stroke Survivors

“…Nevertheless, several prognostication models using clinical variables have been created to better identify patients at highest risk of developing recurrent ischemic stroke. [11][12][13] One of the most commonly used tools is the Stroke Prognostic Instrument-II (SPI-II). 12 SPI-II uses 7 clinical factors to estimate the risk of stroke or death in patients with prior TIA or nondisabling ischemic stroke.…”

“…[11][12][13] One of the most commonly used tools is the Stroke Prognostic Instrument-II (SPI-II). 12 SPI-II uses 7 clinical factors to estimate the risk of stroke or death in patients with prior TIA or nondisabling ischemic stroke. It has been validated in 4 independent cohorts as a modestly effective tool (c-statistic of 0.63-0.65) for stratifying patients into low-, middle-, and high-risk groups for recurrent stroke or death.…”