Follow Us for LinkedIn Updates

Follow now

Back to list

Predicting Stroke Outcome Using Clinical- versus Imaging-based Scoring System

Jan. 2015

Background

Several models to predict outcome in ischemic stroke patients receiving intravenous (i.v.) alteplase can be divided into clinical-based and imaging-based systems. Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) and Dense cerebral artery sign/early infarct signs on admission CT scan, prestroke modified Rankin Scale (mRS) score, Age, Glucose level at baseline, Onset-to-treatment time, and baseline National Institutes of Health Stroke Scale score (DRAGON) are typical imaging- and clinical-based scoring systems, respectively. Therefore, we compared predictability of stroke outcome of clinical (DRAGON)- and imaging (ASPECTS)-based scoring systems.


Methods

We analyzed patients who were diagnosed with middle cerebral artery territory stroke and treated with i.v. alteplase at Gachon University Gil Hospital over 5 years and compared performance of 2 scoring systems for prediction of good functional outcome (mRS, 0-2) with Pearson correlation and area under the curve-receiver operating characteristic (AUC-ROC). In addition, we analyzed predicting power of several clinical factors and 2 scoring systems by multiple regression analysis.


Results

Study population (N = 120) had mean age of 66.2 ± 13.2 years. ASPECTS (r = −.841, P < .0001) and DRAGON (r = .657, P < .0001) were significantly correlated with good functional outcome. In addition, statistical comparisons suggested that ASPECTS (AUC-ROC, .972; 95% confidence interval [CI], .947-.996) is significantly superior to DRAGON (AUC-ROC, .854; 95% CI, .786-.922) in predicting functional outcome (difference between areas, .118 ± .0332; 95% CI, .0559-.180, P = .0002). Multiple regression analysis revealed that ASPECTS was the independent predictor of good prognosis (OR, 6.59 per 1-point increase; 95% CI, 2.35-18.49; P < .0001 and OR, 77.67 for ASPECTS ≥8; 95% CI, 14.30-421.79; P < .0001).


Conclusions

ASPECTS is superior method for predicting functional outcome in acute ischemic stroke patients receiving i.v. alteplase compared with DRAGON and integration of ASPECTS score into clinical care pathway as decision-making tool can be reasonable.

  • Link

    https://www.strokejournal.org/article/S1052-3057(14)00509-6/fulltext
  • Author

    Joon Hyun Baek, Kitae Kim, Yeong-Bae Lee, Kee-Hyung Park, Hyeon-Mi Park, Dong-Jin Shin, Young Hee Sung, Dong Hoon Shin, and Oh Young Bang
  • Keywords

    cerebral infarct, thrombolysis, ASPECT score, stroke
  • Back to list

    TOP