Prediction of Long-term Outcome in the Early Hours Following Acute Ischemic Stroke

doi:10.1001/archneur.1995.00540270038017

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Vol. 52 No. 3, March 1995

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Prediction of Long-term Outcome in the Early Hours Following Acute Ischemic Stroke

Marco Fiorelli, MD, PhD; Annick Alpérovitch, MD; Corrado Argentino, MD; Maria Luisa Sacchetti, MD; Danilo Toni, MD, PhD; Giuliano Sette, MD; Cristina Cavalletti, MD; Maria Cristina Gori, MD; Cesare Fieschi, MD; Italian Acute Stroke Study Group

Arch Neurol. 1995;52(3):250-255.

Abstract

Objective
To develop a model for predicting outcome in the first few hoursafter the onset of an ischemic stroke on the basis of the clinicalfindings obtained during a rapid bedside examination.

Design
Clinical records were retrieved from the data bank of a randomizedmulticenter trial. The resulting case series was split intotwo subgroups that served as a "training set" and a "test set."Logistic regression was applied to the training set to selectthe prognostic predictors among baseline clinical findings.The performances of the model based on independent prognosticpredictors were then validated in the test set.

Setting
Eleven primary care institutions (either hospitals or universityclinics) participating in the Italian Acute Stroke Study onthe efficacy of hemodilution and monosialoganglioside in acuteischemic stroke.

Patients
Consecutive noncomatose patients (N=300) observed within thefirst 6 hours after the onset of a first supratentorial ischemicstroke.

Main Outcome Measure
Death or disablement 4 months after the index stroke. Disablementwas 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-monthpoor outcome rate ranging from 10% (patients aged 70 years oryounger 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 orlower). When a risk of poor outcome of 60% was taken as a cutoff,the accuracy of the prediction was 78%±6% in the trainingset and 72%±9% in the test set.

Conclusion
Long-term outcome can be predicted in the first few hours followingan acute ischemic stroke by means of a simple model based onage and CNS score.

Author Affiliations

From the Department of Neurological Sciences, University "La Sapienza", Rome, Italy (Drs Fiorelli, Argentino, Sacchetti, Toni, Sette, Cavalletti, Gori, and Fieschi); and Unit 360, National Institute of Health and Medical Research (INSERM), Paris, France (Dr Alpérovitch). A complete list of participants in this study appears in the box on page 255.

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