Validating and comparing stroke prognosis scales

Quinn, Terence J; Singh, Sarjit; Lees, Kennedy R.; Bath, Philip M; Myint, Phyo Kyaw

doi:10.1212/wnl.0000000000004332

Cited by 63 publications

(69 citation statements)

References 21 publications

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“…4,7 However, our results are in line with a 2017 analysis based on data from the Virtual International Stroke Trials Archive (ASTRAL AUC = 0.78-0.79; THRIVE AUC = 0.73-0.77). 3 The THRIVE score showed a similar accuracy (AUC ~ 0.7) to its validation study of prospectively collected database registry of patients who TA B L E 2 Univariate prognostic score analysis and cohort-derived pre and post-intervention multivariate logistic regression models underwent endovascular thrombectomy for acute ischemic stroke. 20 In contrast to our data, the latter was validated in older devices that are not in use anymore.…”

Section: Comparison With the Accuracy Of The Prognostic Scores Astrmentioning

confidence: 78%

“…1 However, no single outcome measure can describe or predict all the dimensions of recovery or disability after acute stroke. 3 For example, the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) 4 3 For example, the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) 4 …”

Section: Introductionmentioning

confidence: 99%

“…2 Several prognostic models have been developed to overcome this problem but there is no clear gold-standard. 3 For example, the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) 4 and the Totaled Health Risks in Vascular Events (THRIVE) 5 scores have been extensively and independently validated. They use few clinical variables on their evaluation and are easily applicable to clinical practice, which is of paramount importance given the short therapeutic window for stroke treatments.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic yield of imaging before and after recanalization treatments in ischemic stroke

et al. 2020

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Objectives:The scores to predict outcome in ischemic stroke were validated prior to the approval of modern revascularization treatments. We evaluated the accuracy of pre and post-treatment models in a recent recanalization therapy cohort and whether radiological and ultrasound findings could improve their accuracy. Material & Methods:We included 375 anterior circulation ischemic stroke patients treated with intravenous thrombolysis or thrombectomy during 2017 and 2018.We collected demographic, clinical, and imaging data. We built pre and post-treatment logistic regression models to predict independence (modified Rankin Scale 0-2) at 3 months. The models included the Alberta Stroke Program Early CT Score (ASPECTS), infarct volume (ABC/2 method), and the Thrombolysis in Brain Ischemia (TIBI) ultrasonographic grade of recanalization. We compared areas under the receiver operating characteristic curve (AUC).Results: Our preintervention model, combining neurological deficit severity, age, and admission glycemia, was not improved by the inclusion of ASPECTS (AUC 0.80 vs 0.79, P = .28). Early neurological recovery at 24-hour significantly increased prognostic performance (AUC = 0.85, P < .01), which did not change by adding final infarct volume or the persistence of arterial occlusion of the affected territory (AUC = 0.86 and 0.85, P > .05).Conclusions: Models that combine simple variables such as neurological deficit severity, age, and admission glycemia were the most useful for predicting functional outcome in ischemic stroke patients submitted to revascularization treatments. Pre and post-treatment imaging findings did not enhance prognostic accuracy when compared to the patient's clinical improvement.

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Section: Comparison With the Accuracy Of The Prognostic Scores Astrmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic yield of imaging before and after recanalization treatments in ischemic stroke

et al. 2020

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“…Nevertheless, none of these models have been incorporated in clinical practice [20]. A recent study compared the accuracy of several stroke prognostic scales revealing that the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) score returned the best prognostic performance [19,21]. However, the analyzed sample comprised only baseline clinical and demographic (not neuroimaging) data based models.…”

Section: Discussionmentioning

confidence: 99%

Selection of anterior circulation acute stroke patients for mechanical thrombectomy

et al. 2019

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Background The use of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) patients has increased with a parallel burden in procedural costs. We tested whether a new prognostic score could identify patients who are unlikely to benefit from MT. Methods Patients from our endovascular stroke registry were assessed for imaging and clinical outcome measures and randomly divided into two subsets for derivation and validation. We created a new prognostic score based on clinical and radiological prognostic factors of poor outcome (mRS score ≥ 3) from the derivation cohort. Receiver operating characteristics curve analysis was used to assess the discrimination ability of the score. The score was then validated and compared to the MR PREDICTS score. Results The derivation/validation included 270/116 patients, respectively. After multivariate logistic regression analysis, pre stroke mRS, age, admission glycaemia, admission NIHSS, collateral flow, Clot Burden Score, Alberta Stroke Program Early CT score were used to create a new prognostic scoring system called Tor Vergata Stroke Score (TVSS). TVSS revealed a good prognostic accuracy with an AUC of 0.825 [95% CI 0.77-0.88] in the derivation cohort and an AUC of 0.820 [95% CI 0.74-0.90] in the validation cohort. When compared to the MR PREDICTS in the validation cohort, TVSS demonstrated higher prediction ability which was, however, not statistically significant (0.80 vs 0.78; P = 0.26). Conclusions TVSS is a reliable tool for selection of AIS candidates for MT and optimization of transfer to comprehensive stroke centers.

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“…However, the variables for acute treatment are lacking in the most prominent current prognostic scales. 3 Moreover, to be used in the emergency clinical setting, a prognostic score should be parsimonious, that is, encompass a low number of items, all fast and easy to assess. One of the leanest scores contains only 2 variables, age and NIH Stroke Scale (NIHSS) score, and was validated in the Virtual International Stroke Trials Archive (VISTA).…”

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confidence: 99%

A novel biomarker-based prognostic score in acute ischemic stroke

et al. 2019

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ObjectivesTo derive and externally validate a copeptin-based parsimonious score to predict unfavorable outcome 3 months after an acute ischemic stroke (AIS).MethodsThe derivation cohort consisted of patients with AIS enrolled prospectively at the University Hospital Basel, Switzerland. The validation cohort was prospectively enrolled after the derivation cohort at the University Hospital of Bern and University Hospital Basel, Switzerland, as well as Frankfurt a.M., Germany. The score components were copeptin levels, age, NIH Stroke Scale, and recanalization therapy (CoRisk score). Copeptin levels were measured in plasma drawn within 24 hours of AIS and before any recanalization therapy. The primary outcome of disability and death at 3 months was defined as modified Rankin Scale score of 3 to 6.ResultsOverall, 1,102 patients were included in the analysis; the derivation cohort contributed 319 patients, and the validation cohort contributed 783. An unfavorable outcome was observed among 436 patients (40%). For the 3-month prediction of disability and death, the CoRisk score was well calibrated in the validation cohort, for which the area under the receiver operating characteristic curve was 0.819 (95% confidence interval [CI] 0.787–0.849). The calibrated CoRisk score correctly classified 75% of patients (95% CI 72–78). The net reclassification index between the calibrated CoRisk scores with and without copeptin was 46% (95% CI 32–60).ConclusionsThe biomarker-based CoRisk score for the prediction of disability and death was externally validated, was well calibrated, and performed better than the same score without copeptin.ClinicalTrials.gov identifierNCT00390962 (derivation cohort) and NCT00878813 (validation cohort).

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Validating and comparing stroke prognosis scales

Abstract: Our comparative analyses confirm differences in the prognostic accuracy of stroke scales. However, even the best performing scale had prognostic accuracy that may not be sufficient as a basis for clinical decision-making.

Cited by 63 publications

References 21 publications

Prognostic yield of imaging before and after recanalization treatments in ischemic stroke

Prognostic yield of imaging before and after recanalization treatments in ischemic stroke

Selection of anterior circulation acute stroke patients for mechanical thrombectomy

A novel biomarker-based prognostic score in acute ischemic stroke

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