Objectives – According to most existing models, a computer is usually needed for predicting stroke outcome. Our purpose was to construct a simple and reliable prognostic scale not requiring the use of a calculating machine. Materials and Methods – The scale (the Bologna Outcome Algorithm for Stroke-BOAS) was obtained in 221 patients with ischemic stroke not undergoing thrombolysis, and was then validated in a test group of 100 different patients. Outcome was assessed at 9 months as the number of dependent or dead patients (modified Rankin scale – mRS >2). Results – By a preliminary systematic univariate analysis, 25 out of 415 baseline variables were found to be associated with a mRS>2 independently of stroke severity and age. Subsequent multivariable analyses led to a final model based on 5 dichotomous risk factors (RF): National Institutes of Health Stroke Scale score >=10, age >=78 years, need of urinary catheter, oxygen administration and persistence of upper limb paralysis at discharge from stroke unit. The patients with 2 or more RF (53%) had a mRS>2 in 91% of cases, and were dead in 42% of cases. With 0-1 RF the two percentages were 24% and 2% respectively (overall accuracy of prediction 83.9%, area under ROC curve [AUC] 0.891). In the test group the accuracy was 79.0% and the AUC was 0.839. Conclusions – The need of urinary catheter, oxygen administration and persistence of upper limb paralysis, together with stroke severity and advanced age, allow a simple and accurate prediction of dependency or death after ischemic stroke.
A simple scoring system for outcome prediction of ischemic stroke
MUSCARI, ANTONIO;ZOLI, MARCO
2011
Abstract
Objectives – According to most existing models, a computer is usually needed for predicting stroke outcome. Our purpose was to construct a simple and reliable prognostic scale not requiring the use of a calculating machine. Materials and Methods – The scale (the Bologna Outcome Algorithm for Stroke-BOAS) was obtained in 221 patients with ischemic stroke not undergoing thrombolysis, and was then validated in a test group of 100 different patients. Outcome was assessed at 9 months as the number of dependent or dead patients (modified Rankin scale – mRS >2). Results – By a preliminary systematic univariate analysis, 25 out of 415 baseline variables were found to be associated with a mRS>2 independently of stroke severity and age. Subsequent multivariable analyses led to a final model based on 5 dichotomous risk factors (RF): National Institutes of Health Stroke Scale score >=10, age >=78 years, need of urinary catheter, oxygen administration and persistence of upper limb paralysis at discharge from stroke unit. The patients with 2 or more RF (53%) had a mRS>2 in 91% of cases, and were dead in 42% of cases. With 0-1 RF the two percentages were 24% and 2% respectively (overall accuracy of prediction 83.9%, area under ROC curve [AUC] 0.891). In the test group the accuracy was 79.0% and the AUC was 0.839. Conclusions – The need of urinary catheter, oxygen administration and persistence of upper limb paralysis, together with stroke severity and advanced age, allow a simple and accurate prediction of dependency or death after ischemic stroke.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
