The Orpington Prognostic Scale: A predictive tool for discharge destination and outcomes in stroke survivors admitted to a hyperacute stroke unit

Abstract

Introduction: An accurate assessment of the severity of impairment and prediction of prognosis following stroke is important for determining rehabilitation needs. This study investigates predictive ability of the Orpington Prognostic Scale (OPS) administered within 72 hours of stroke onset, in determining discharge destination post admission to a Hyper Acute Stroke Unit (HASU).Method: Prospective analysis of OPS data collected from 219 patients with confirmed diagnosis of stroke admitted to King's College Hospital, HASU. OPS scores were recorded between 0-72hours of admission and compared to discharge destination at 72 hours. Baseline OPS scores were categorised into three groups for comparison of variables. Predictive ability of the tool and associations with other variables were analysed using logistic regression and multivariate analysis.Results: Low OPS score (<3.2) had high positive predictive value (PPV 88.63%) for determining discharge home and high OPS score (>3.2) had high predictive ability (PPV 98.39%) for further inpatient management in specialist stroke or medical rehabilitation units. The OPS showed good predictive ability (Odds ratio 27.691 with 95% confidence interval 9.852 -77.825) to determine outcome after admission to HASU independent of the age, gender, type and site of stroke, previous social support and co-morbidity. Conclusion:OPS could be a valuable tool in predicting the discharge destination from a HASU by early identification of rehabilitation needs 72 hours after stroke following initial screening. OPS <3.2 are highly likely to go home with or without support/therapy, whereas OPS > 3.2 are highly likely to require further medical/therapy input in an inpatient setting.