There seems to be no point in even doing this prediction, I can see no use for survivors at all except as a way to deny therapy.
http://stroke.ahajournals.org/content/early/2016/05/12/STROKEAHA.116.012802.abstract?sid=8aed9298-344e-4c0e-88de-190cae36e5ff
- Charith Cooray, MD,
- Michael Mazya, MD, PhD,
- Matteo Bottai, PhD,
- Laura Dorado, MD, PhD,
- Ondrej Skoda, MD, PhD,
- Danilo Toni, MD, PhD,
- Gary A. Ford, MD, PhD,
- Nils Wahlgren, MD, PhD and
- Niaz Ahmed, MD, PhD
+ Author Affiliations
- Correspondence to Charith Cooray, MD, Karolinska Stroke Research Unit, Department of Neurology Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden. E-mail charith.cooray@karolinska.se
-
Presented in part at the European Stroke Organization Conference, Barcelona, Spain, May 10–12, 2016.
Abstract
Background and Purpose—ASTRAL
(Acute Stroke Registry and Analysis of Lausanne) and DRAGON (includes
dense middle cerebral artery sign, prestroke
modified Rankin Scale score, age, glucose,
onset to treatment, National Institutes of Health Stroke Scale score)
are 2 recently
developed scores for predicting functional
outcome after acute stroke in unselected acute ischemic stroke patients
and in
patients treated with intravenous
thrombolysis, respectively. We aimed to perform external validation of
these scores to assess
their predictive performance in the large
multicentre Safe Implementation of Thrombolysis in Stroke-International
Stroke Thrombolysis
Register.
Methods—We
calculated the ASTRAL and DRAGON scores in 36 131 and 33 716 patients,
respectively, registered in Safe Implementation
of Thrombolysis in Stroke-International
Stroke Thrombolysis Register between 2003 and 2013. The proportion of
patients with
3-month modified Rankin Scale scores of 3 to 6
was observed for each score point and compared with the predicted
proportion
according to the risk scores. Calibration was
assessed using calibration plots, and predictive performance was
assessed using
area under the curve of the receiver
operating characteristic. Multivariate logistic regression coefficients
for the variables
in the 2 scores were compared with the
original derivation cohorts.
Results—The ASTRAL
showed an area under the curve of 0.790 (95% confidence interval,
0.786–0.795) and the DRAGON an area under the
curve of 0.774 (95% confidence interval,
0.769–0.779). All ASTRAL parameters except range of visual fields and
all DRAGON
parameters were significantly associated with
functional outcome in multivariate analysis.
Conclusions—The
ASTRAL and DRAGON scores show an acceptable predictive performance.
ASTRAL does not require imaging-data and therefore
may have an advantage for the use in
prehospital patient assessment. Prospective studies of both scores
evaluating the impact
of their use on patient outcomes after
intravenous thrombolysis and endovascular therapy are needed.
No comments:
Post a Comment