Prognosis scales do nothing to get any stroke survivor any closer to recovery. You blithering idiots, the goal is 100% recovery for all survivors, not trying to predict who will recover better. Get the hell out of stroke if that is not your goal. Be glad to talk to any of you, I'm not afraid, Are you?
http://www.neurology.org/content/early/2017/08/09/WNL.0000000000004332.short
- Terence J. Quinn, MD*,
- Sarjit Singh, BSc (Med Sci)*,
- Kennedy R. Lees, MD,
- Philip M. Bath, PhD and
- Phyo K. Myint, MD On behalf of the VISTA Collaborators
- Correspondence to Dr. Quinn: Terry.Quinn@glasgow.ac.uk
-
Neurology 10.1212/WNL.0000000000004332
- Abstract
- Full Text (PDF)
- Also available:
- Data Supplement
- Coinvestigators
Abstract
Objective: To compare the prognostic accuracy of various acute stroke prognostic scales using a large, independent, clinical trials
dataset.
Methods: We directly
compared 8 stroke prognostic scales, chosen based on focused literature
review (Acute Stroke Registry and Analysis
of Lausanne [ASTRAL]; iSCORE; iSCORE-revised;
preadmission comorbidities, level of consciousness, age, and neurologic
deficit
[PLAN]; stroke subtype, Oxfordshire Community
Stroke Project, age, and prestroke modified Rankin Scale [mRS] [SOAR];
modified
SOAR; Stroke Prognosis Instrument 2 [SPI2]; and
Totaled Health Risks in Vascular Events [THRIVE]) using individual
patient-level
data from a clinical trials archive (Virtual
International Stroke Trials Archive [VISTA]). We calculated area under
receiver
operating characteristic curves (AUROC) for each
scale against 90-day outcomes of mRS (dichotomized at mRS >2),
Barthel Index
(>85), and mortality. We performed 2
complementary analyses: the first limited to patients with complete data
for all components
of all scales (simultaneous) and the second
using as many patients as possible for each individual scale (separate).
We compared
AUROCs and performed sensitivity analyses
substituting extreme outcome values for missing data.
Results: In total,
10,777 patients contributed to the analyses. Our simultaneous analyses
suggested that ASTRAL had greatest prognostic
accuracy for mRS, AUROC 0.78 (95% confidence
interval [CI] 0.75–0.82), and SPI2 had poorest AUROC, 0.61 (95% CI
0.57–0.66).
Our separate analyses confirmed these results:
ASTRAL AUROC 0.79 (95% CI 0.78–0.80 and SPI2 AUROC 0.60 (95% CI
0.59–0.61).
On formal comparative testing, there was a
significant difference in modified Rankin Scale AUROC between ASTRAL and
all other
scales. Sensitivity analysis identified no
evidence of systematic bias from missing data.
Conclusions: Our comparative analyses confirm differences in the prognostic accuracy of stroke scales. However, even the best performing
scale had prognostic accuracy that may not be sufficient as a basis for clinical decision-making.
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