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Stroke Prognostication using Age and NIH Stroke Scale: SPAN-100.

Gustavo Saposnik1, Amy K Guzik, Mathew Reeves

  • 1Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada. saposnikg@smh.ca

Neurology
|November 24, 2012
PubMed
Summary
This summary is machine-generated.

The SPAN-100 index effectively predicts outcomes and hemorrhage risk in acute ischemic stroke patients treated with tissue plasminogen activator (tPA). It identifies patients unlikely to benefit from tPA, aiding treatment decisions.

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Area of Science:

  • Neurology
  • Stroke Medicine
  • Clinical Prognostication

Background:

  • Age and stroke severity significantly impact acute ischemic stroke outcomes.
  • Integrating these prognostic factors into routine clinical practice for thrombolysis decisions remains challenging.

Purpose of the Study:

  • To evaluate the efficacy of the Stroke Prognostication using Age and NIH Stroke Scale (SPAN-100) index.
  • To assess the SPAN-100 index's ability to predict clinical response and intracerebral hemorrhage (ICH) risk following IV tissue plasminogen activator (tPA) treatment.

Main Methods:

  • The SPAN-100 index was developed by combining patient age and NIH Stroke Scale (NIHSS) scores (≥100).
  • The index was applied to patients from the National Institute of Neurological Disorders and Stroke (NINDS) tPA stroke trials (Parts I and II).
  • Outcomes analyzed included ICH and composite favorable outcomes at 3 months, using logistic regression.

Main Results:

  • Among 624 patients, 9.9% were SPAN-100 positive.
  • SPAN-100-positive patients had higher ICH rates (42% vs. 12% with tPA; 19% vs. 5% without tPA).
  • tPA demonstrated benefit in SPAN-100-negative patients (55.4% vs. 40.2%), but not in SPAN-100-positive patients (5.6% vs. 3.9%).

Conclusions:

  • The SPAN-100 index offers a simple method to estimate clinical response and hemorrhagic complication risk after tPA for acute ischemic stroke.
  • Further validation in larger, contemporary patient cohorts is warranted.