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A prediction model of 1-year mortality for acute ischemic stroke patients
Yang Wang1, Lynette L-Y Lim, Richard F Heller
1Department of Neurology, John Hunter Hospital, NSW, Australia.
Objective:
To develop a prediction model for 1-year mortality in patients with acute ischemic stroke, with the model to be at least as useful and accurate as other previously developed prediction models.
Design:
Retrospective cohort study.
Setting:
Neurology department at an Australian tertiary teaching hospital.
Participants:
Four hundred forty consecutive patients diagnosed with acute ischemic stroke between July 1, 1995, and June 30, 1997.
Interventions:
Two hundred twenty-three (51%) patients were randomly assigned to the derivation sample to develop a prediction model using the Cox proportional hazards model. The model was then validated in a validation sample of 217 (49%) patients.
Main Outcome Measure:
One-year mortality.
Results:
Eight clinical predictors were included in the final model: unconsciousness (3 points), dysphagia (7 points), urinary incontinence (9 points), both sides affected (4 points), hyperthermia (4 points), ischemic heart disease (3 points), peripheral vascular disease (3 points), and diabetes mellitus (2 points). Patients with scores of 10 or higher were allocated to the high-risk group, which had a 1-year mortality rate of 76%, compared with a 1-year mortality rate of 8% in the low-risk group. There was no statistically significant difference in terms of sensitivity, specificity, and positive predictive value in the validation sample.
Conclusion:
We developed a predictive model for 1-year mortality in acute ischemic stroke patients. The model is easy to use and is comparable in its accuracy with other predictive models.