An Integer-based Score to Predict

An integer-based score to

predict functional jr5in acute

ischemic strokeThe ASTRAL score

Neurology 78 June 12, 2012 1917

: To develop and validate a simple, integer-based score to predict functional outcome in

acute ischemic stroke (AIS) using variables readily available after emergency room admission.

Objective

stroke physicians in treatment realistic prognostic expectations and to

plan the long-term living setting. nonrandomized studies to control for case-

mix variation controlled clinical trials as a selection

criterion.

prediction of stroke outcome

Age (A), severity of stroke (S) measured by

admission NIH Stroke Scale score, Stroke onset to admission time (T), range of visual fields (R), acute glucose (A), level of consciousness(L)

ASTRAL SCORE

The prognostic score was developed in a cohort of patients from the Acute Stroke Registry: age, gender, onset to admission time, prestroke mRS score, the type of clinical deficit according to the NIH Stroke

Scale (NIHSS) score, the absolute NIHSS score at admission, vascular territory and localization of the stroke by TOAST cardiovascular risk factors and comorbidities, prestroke medication,

METHODS

cohortof patients from the Acute Stroke

Registry and Analysis of Lausanne

(ASTRAL).8

The derived prognostic score

was validatedexternally in 2 independent

cohorts from the Athens9 and

Vienna10Stroke Registries

For this analysis, we included all patientsadmitted between

January 1, 1998, and December 31,

2010 (Athens), and between October 10, 1998, and December

29, 2001 (Vienna).A logist

: age, gender, onset to admission Time , prestroke mRS score, the type of clinical deficit accordin gto the NIH Stroke

Scale (NIHSS) score , the absolute NIHSSscore at admission, vascular territord localization of the\\Treatment (TOAST) mechanism,11 cardiovascular risk

factors and comorbidities, prestroke medication, basic findings

on brain imaging at admission (noncontrast CT or T2 or

The following covariates wereincluded in the multivariate analysis

Covariates Score points Age: for every 5 ya 1 Severity: for every NIHSS pointa 1 Time delay from onset to admission >3

hb 2 Range of visual field defectc 2 Acute glucose >7.3 or <3.7 mmol/Ld

1 Level of consciousness decreasede 3

Six covariates were identified as independent

predictors of unfavorable outcome in multiple

logistic regression analysis: age, NIHSS score at ad-

mission, delay from stroke onset to admission, visual

field defect, glucose at admission, and impaired level of

consciousness

1,967 patients registered in the

,322 were excluded

mean NIHSS score at admission 8.0 7.8

The mean age was 68.2

42.8% were womens

RESULTS

The median score value was 23(range 5-63)

can be assessed in the emergency room to predict ischemic stroke

outcome that time to admission is an independent predictor of outcomeat 3

months in patients arriving within 24 hours

DISCUSSION

that time to admission is an independent predictor of outcome

that time to admission is an independent predictor of outcome

the ASTRAL score in its current form does not require information

from brain imaging (other than excluding

intracerebral hemorrhage, It was derived from a large registry of

consecutive patients and has performed well during external

validation in 2 independent large stroke registries

The use of the ASTRAL score as a selection criterion could help identify and recruit those patients who would have an increased likelihood of achieving a positive result; the rapid and easy (especially with the use of the color chart) calculation of the score at an early stage such as hospital

admission emphasizes the feasibility of use of the ASTRAL score as a selection tool for recruitment of patients in randomized clinical trials

Thank you