Prediction of long-term outcome in the early hours following acute ischemic stroke. Italian Acute Stroke Study Group
M. Fiorelli, A. Alperovitch, C. Argentino, M. L. Sacchetti, D. Toni, G. Sette, C. Cavalletti, M. C. Gori and C. Fieschi
Department of Neurological Sciences, University La Sapienza, Rome, Italy.
OBJECTIVE: To develop a model for predicting outcome in the first few hours
after the onset of an ischemic stroke on the basis of the clinical findings
obtained during a rapid bedside examination. DESIGN: Clinical records were
retrieved from the data bank of a randomized multicenter trial. The
resulting case series was split into two subgroups that served as a
"training set" and a "test set." Logistic regression was applied to the
training set to select the prognostic predictors among baseline clinical
findings. The performances of the model based on independent prognostic
predictors were then validated in the test set. SETTING: Eleven primary
care institutions (either hospitals or university clinics) participating in
the Italian Acute Stroke Study on the efficacy of hemodilution and
monosialoganglioside in acute ischemic stroke. PATIENTS: Consecutive
noncomatose patients (N = 300) observed within the first 6 hours after the
onset of a first supratentorial ischemic stroke. MAIN OUTCOME MEASURE:
Death or disablement 4 months after the index stroke. Disablement was
defined as a score of 3 or higher on the Rankin Scale. RESULTS: Age and CNS
score defined six risk groups with a predicted 4-month poor outcome rate
ranging from 10% (patients aged 70 years or younger and with an initial CNS
score of 7 or higher) to 89% (patients older than 70 years and with a CNS
score of 4.5 or lower). When a risk of poor outcome of 60% was taken as a
cutoff, the accuracy of the prediction was 78% +/- 6% in the training set
and 72% +/- 9% in the test set. CONCLUSION: Long-term outcome can be
predicted in the first few hours following an acute ischemic stroke by
means of a simple model based on age and CNS score.