External Validation of the ASTRAL and DRAGON Scores for Prediction of Functional Outcome in Stroke

Abstract

The 2 most recently developed scores were designed to predict functional outcome after acute stroke, one in unselected acute ischemic stroke patients (Acute Stroke Registry and Analysis of Lausanne [ASTRAL]), 10 and the other in acute stroke patients treated with intravenous tPA (DRAGON includes dense middle cerebral artery sign, Background and Purpose-ASTRAL (Acute Stroke Registry and Analysis of Lausanne) and DRAGON (includes dense middle cerebral artery sign, prestroke modified Rankin Scale score, age, glucose, onset to treatment, National Institutes of Health Stroke Scale score) are 2 recently developed scores for predicting functional outcome after acute stroke in unselected acute ischemic stroke patients and in patients treated with intravenous thrombolysis, respectively. We aimed to perform external validation of these scores to assess their predictive performance in the large multicentre Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register. Methods-We calculated the ASTRAL and DRAGON scores in 36 131 and 33 716 patients, respectively, registered in Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register between 2003 and 2013. The proportion of patients with 3-month modified Rankin Scale scores of 3 to 6 was observed for each score point and compared with the predicted proportion according to the risk scores. Calibration was assessed using calibration plots, and predictive performance was assessed using area under the curve of the receiver operating characteristic. Multivariate logistic regression coefficients for the variables in the 2 scores were compared with the original derivation cohorts. Results-The

A COACHS Nomogram to Predict the Probability of Three-Month Unfavorable Outcome after Acute Ischemic Stroke in Chinese Patients

“…Several prognostic scores [3][4][5][6][7] and some models [16,17] have identified some demographic and clinical characteristics that may be used to predict clinical outcome. However, all these scores and models for individualized prediction of outcome are limited by the use of dichotomization/categorization of predictors including NIHSS score and age.…”

“…All patients were clinically evaluated 3 months after the acute ischemic stroke by means of the mRS. The primary outcome was unfavorable functional result interpreted as mRS comprised between 3 and 6 (i.e., poor prognosis) at 3 months [7]. Baseline NIHSS and 3-month mRS were performed by assessors who were trained and certified in the use of these tools.…”

“…Several prognostic scores [3][4][5][6][7], such as Acute Stroke Registry and Analysis of Lausanne score, Totaled Health Risks in Vascular Events score, have been developed to predict unfavorable functional outcome in patients with acute ischemic stroke. Age and stroke severity of patients have been established as the strongest predictors of unfavorable outcome in the acute phase of stroke [3][4][5][6][7][8].…”

Impact of Transcranial Doppler Ultrasound on Logistics and Outcomes in Stroke Thrombolysis

“…For categorical variables, we calculated percentage proportions by dividing the number of events by the total number of patients, excluding missing or unknown cases, as in previous SITS publications. 10,12,13 For calculation of significance of difference between proportions, the Pearson χ 2 method was used. To adjust for confounding effects of baseline differences between the groups, multivariate logistic regression analyses were performed to demonstrate whether TCD performed (1) before and (2) during IVT is independently associated with outcomes.…”

Contribution of Neuro-Imaging for Prediction of Functional Recovery after Ischemic Stroke

“…According to common guidelines, patients with an acute cerebrovascular attack should be admitted to a specialized and adequately equipped hospital or stroke unit, where the decision on the best treatment will not only be based on clinical data [4,] but also be supported by results from imaging and laboratory tests. At least one imaging study - computed tomography (CT) or magnetic resonance imaging (MRI) - is required to prove the diagnosis and rule out large morphological lesions, but simple and even complex clinical scores including morphologic imaging data require perspective studies to prove their validity for the prediction of therapeutic efficacy [5]. Since the existence of functionally impaired but morphological intact tissue is the prerequisite for the efficacy of reperfusion therapy in acute ischemia, many studies testing invasive treatment in the first hours after stroke were based on penumbral/mismatch imaging for recruiting patients [6,7,8,9]; however, criteria for the prediction of efficacy in individual cases were not assessed.…”