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Validation of the DRAGON score in 12 stroke centers in anterior and posterior circulation
Daniel Strbian1, David J Seiffge, Lorenz Breuer
1From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., A.M., S.C., T.T.); Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland (D.J.S., P.A.L., S.T.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (H.N., J.O.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia (A.M., C.B., S.M.D.); Department of Neurology, Box Hill Hospital, Box Hill, Australia (S.C., C.B.); Department of Neurology, University Lille Nord de France, Lille, France (R.B., D.L.); Department of Neurology, Hospital Clínic Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain (V.O., A.C.); Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland (B.W.); Department of Neurology, University of Bern, Bern, Switzerland (S.J., H.P.M.); and Department of Neurology, University of Perugia, Perugia, Italy (V.C.).
Background And Purpose:
The DRAGON score predicts functional outcome in the hyperacute phase of intravenous thrombolysis treatment of ischemic stroke patients. We aimed to validate the score in a large multicenter cohort in anterior and posterior circulation.
Methods:
Prospectively collected data of consecutive ischemic stroke patients who received intravenous thrombolysis in 12 stroke centers were merged (n=5471). We excluded patients lacking data necessary to calculate the score and patients with missing 3-month modified Rankin scale scores. The final cohort comprised 4519 eligible patients. We assessed the performance of the DRAGON score with area under the receiver operating characteristic curve in the whole cohort for both good (modified Rankin scale score, 0-2) and miserable (modified Rankin scale score, 5-6) outcomes.
Results:
Area under the receiver operating characteristic curve was 0.84 (0.82-0.85) for miserable outcome and 0.82 (0.80-0.83) for good outcome. Proportions of patients with good outcome were 96%, 93%, 78%, and 0% for 0 to 1, 2, 3, and 8 to 10 score points, respectively. Proportions of patients with miserable outcome were 0%, 2%, 4%, 89%, and 97% for 0 to 1, 2, 3, 8, and 9 to 10 points, respectively. When tested separately for anterior and posterior circulation, there was no difference in performance (P=0.55); areas under the receiver operating characteristic curve were 0.84 (0.83-0.86) and 0.82 (0.78-0.87), respectively. No sex-related difference in performance was observed (P=0.25).
Conclusions:
The DRAGON score showed very good performance in the large merged cohort in both anterior and posterior circulation strokes. The DRAGON score provides rapid estimation of patient prognosis and supports clinical decision-making in the hyperacute phase of stroke care (eg, when invasive add-on strategies are considered).
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