<scp>ASTRAL</scp>,<scp> DRAGON</scp> and <scp>SEDAN</scp> scores predict stroke outcome more accurately than physicians

Ntaios, George; Gioulekas, Fotios; Papavasileiou, Vasileios; Strbian, Daniel; Michel, Patrik

doi:10.1111/ene.13100

Cited by 38 publications

(34 citation statements)

References 21 publications

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“…23 For outcome prognostications, validated scores perform better than clinicians. 24,25 A recent study compared the ASTRAL score to estimates of 244 clinicians with expertise in stroke for 720 real stroke scenarios for the prediction of 3-month mRS score of 3 to 6 in the general ischemic stroke population. 25 Overall, 86.5% of ASTRAL-based estimates were accurate, as opposed to 56.8% of estimated by clinicians with expertise in stroke.…”

Section: Examplesmentioning

confidence: 99%

“…24,25 A recent study compared the ASTRAL score to estimates of 244 clinicians with expertise in stroke for 720 real stroke scenarios for the prediction of 3-month mRS score of 3 to 6 in the general ischemic stroke population. 25 Overall, 86.5% of ASTRAL-based estimates were accurate, as opposed to 56.8% of estimated by clinicians with expertise in stroke. The majority of the physicians' inaccurate estimates (n = 231, 76.0%) were overly pessimistic, that is, overestimated the probability of unfavorable outcome at 3 months.…”

Section: Examplesmentioning

confidence: 99%

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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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Section: Examplesmentioning

confidence: 99%

Section: Examplesmentioning

confidence: 99%

A novel biomarker-based prognostic score in acute ischemic stroke

et al. 2019

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“…This score could predict the outcome after thrombolysis with high accuracy (AVC 0.84), and was better than the prediction by experienced physicians (mRS5-6 at 3 months: 80.4 vs. 40.4% [17]).…”

Section: Structural Imagingmentioning

confidence: 99%

“…The addition of more clinical variables in a relatively simple model improved the prediction accuracy slightly (83.9% [15]). The complex model based on an integer score from age, severity of stroke at admission by National Institute of Health Stroke Scale (NIHSS), time from stroke onset to admission, range of visual fields, acute glucose value, and level of consciousness reached an AUC of 0.850 in the original population and of 0.903 in a stroke population pooled from 3 centers [16] and was superior to the prediction by experienced physicians (3 months mRS: 286.5 vs. 56.8% [17]). The changes on the NIHSS and of symptoms and signs of traditional Chinese medicine during the first 5 days after stroke predicted the 90-day outcome [18].…”

Section: Introductionmentioning

confidence: 99%

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

Heiss¹

2017

Cerebrovasc Dis

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Prediction measures of recovery and outcome after stroke perform with only modest levels of accuracy if based only on clinical data. Prediction scores can be improved by including morphologic imaging data, where size, location, and development of the ischemic lesion is best documented by magnetic resonance imaging. In addition to the primary lesion, the involvement of fiber tracts contributes to prognosis, and consequently the use of diffusion tensor imaging (DTI) to assess primary and secondary pathways improves the prediction of outcome and of therapeutic effects. The recovery of ischemic tissue and the progression of damage are dependent on the quality of blood supply. Therefore, the status of the supplying arteries and of the collateral flow is not only crucial for determining eligibility for acute interventions, but also has an impact on the potential to integrate areas surrounding the lesion that are not typically part of a functional network into the recovery process. The changes in these functional networks after a localized lesion are assessed by functional imaging methods, which additionally show altered pathways and activated secondary centers related to residual functions and demonstrate changes in activation patterns within these networks with improved performance. These strategies in some instances record activation in secondary centers of a network, for example, also in homolog contralateral areas, which might be inhibitory to the recovery of primary centers. Such findings might have therapeutic consequences, for example, image-guided inhibitory stimulation of these areas. In the future, a combination of morphological imaging including DTI of fiber tracts and activation studies during specific tasks might yield the best information on residual function, reserve capacity, and prospects for recovery after ischemic stroke.

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“…Stroke represents the largest proportion of papers published, including those on pathophysiology , acute stroke management and the outcome of patients who have suffered stroke . Stroke is a worldwide problem, but its prevalence varies and may reflect both the genetic and environmental contributions to stroke, both in turn reflecting the known risk factors for stroke.…”

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confidence: 99%