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Validating and comparing stroke prognosis scales.

Terence J Quinn1, Sarjit Singh2, Kennedy R Lees2

  • 1From the Institute of Cardiovascular and Medical Sciences (T.J.Q., K.R.L.) and Undergraduate Medical School (S.S.), University of Glasgow; Stroke Trials Unit, Division of Clinical Neuroscience (P.M.B.), University of Nottingham; and School of Medicine (P.K.M.), Medical Sciences and Nutrition, University of Aberdeen, UK. Terry.Quinn@glasgow.ac.uk.

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Summary
This summary is machine-generated.

The Acute Stroke Registry and Analysis of Lausanne (ASTRAL) scale demonstrated the highest prognostic accuracy for stroke outcomes, while the Stroke Prognosis Instrument 2 (SPI2) performed poorest. Even the best scales may lack sufficient accuracy for clinical decisions.

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Area of Science:

  • Neurology
  • Clinical Trials
  • Biostatistics

Background:

  • Accurate prognostic scales are crucial for acute stroke management and clinical decision-making.
  • Several stroke prognostic scales exist, but their comparative accuracy in large, independent datasets is not well-established.

Purpose of the Study:

  • To compare the prognostic accuracy of eight different acute stroke prognostic scales.
  • To evaluate scales using a large, independent clinical trials dataset (Virtual International Stroke Trials Archive [VISTA]).

Main Methods:

  • Direct comparison of eight stroke prognostic scales: ASTRAL, iSCORE, iSCORE-revised, PLAN, SOAR, modified SOAR, SPI2, and THRIVE.
  • Utilized individual patient-level data from VISTA, analyzing 90-day outcomes including modified Rankin Scale (mRS), Barthel Index, and mortality.
  • Calculated area under the receiver operating characteristic curves (AUROC) for each scale, performing both simultaneous and separate patient analyses, with sensitivity analyses for missing data.

Main Results:

  • Analysis included 10,777 patients.
  • The ASTRAL scale showed the highest prognostic accuracy for mRS (AUROC 0.78-0.79), while SPI2 had the poorest (AUROC 0.60-0.61).
  • Formal testing confirmed significant differences in mRS AUROC between ASTRAL and all other scales; no systematic bias from missing data was detected.

Conclusions:

  • Significant differences exist in the prognostic accuracy of various acute stroke scales.
  • Even the top-performing scale (ASTRAL) may not possess sufficient prognostic accuracy for direct clinical decision-making.