Useless predictions again. WE NEED SOLUTIONS THAT STOP THESE PROBLEMS. DO YOU NOT UNDERSTAND THAT SIMPLE COMMAND? Nothing here will help get survivors recovered, you're fired!
HERMES-24 Score Derivation and Validation for Simple and Robust Outcome Prediction After Large Vessel Occlusion Treatment
Abstract
BACKGROUND:
Clinicians
need simple and highly predictive prognostic scores to assist practical
decision-making. We aimed to develop a simple outcome prediction score
applied 24 hours after anterior circulation acute ischemic stroke
treatment with endovascular thrombectomy and validate it in patients
treated both with and without endovascular thrombectomy.
METHODS:
Using
the HERMES (Highly Effective Reperfusion Evaluated in Multiple
Endovascular Stroke Trials) collaboration data set (n=1764), patients in
the endovascular thrombectomy arm were divided randomly into a
derivation cohort (n=430) and a validation cohort (n=441). From a set of
candidate predictors, logistic regression modeling using forward
variable selection was used to select a model that was both parsimonious
and highly predictive for modified Rankin Scale (mRS) ≤2 at 90 days.
The score was validated in validation cohort, control arm (n=893), and
external validation cohorts from the ESCAPE-NA1 (Efficacy and Safety of
Nerinetide for the Treatment of Acute Ischaemic Stroke; n=1066) and
INTERRSeCT (Identifying New Approaches to Optimize Thrombus
Characterization for Predicting Early Recanalization and Reperfusion
With IV Alteplase and Other Treatments Using Serial CT Angiography;
n=614).
RESULTS:
In
the derivation cohort, we selected 2 significant predictors of mRS ≤2
(National Institutes of Health Stroke Scale score at 24 hours and age
[β-coefficient, 0.34 and 0.06]) and derived the HERMES-24 score: age
(years)/10+National Institutes of Health Stroke Scale score at 24 hours.
The HERMES-24 score was highly predictive for mRS ≤2 (c-statistic 0.907
[95% CI, 0.879–0.935]) in the derivation cohort. In the validation
cohort and the control arm, the HERMES-24 score predicts mRS ≤2
(c-statistic, 0.914 [95% CI, 0.886–0.944] and 0.909 [95% CI,
0.887–0.930]). Observed provability of mRS ≤2 ranged between 3.1% and
3.4% when HERMES-24 score ≥25, while it ranged between 90.6% and 93.0%
when HERMES-24 score <10 in the derivation cohort, validation cohort,
and control arm. The HERMES-24 score also showed c-statistics of 0.894
and 0.889 for mRS ≤2 in the ESCAPE-NA1 and INTERRSeCT populations.
CONCLUSIONS:
The
post-treatment HERMES-24 score is a simple validated score that
predicts a 3-month outcome after anterior circulation large vessel
occlusion stroke regardless of intervention, which helps prognostic
discussion with families on day 2.
Graphical Abstract
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