Developing predictive models of excellent and devastating outcome after stroke

• Published in: Age and ageing Vol. 41; no. 4; pp. 560 - 564
• Main Authors: Reid, John M, Dai, Dingwei, Christian, Christine, Reidy, Yvette, Counsell, Carl, Gubitz, Gord J, Phillips, Stephen J
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.07.2012; Oxford Publishing Limited (England)
• Subjects: Aged; Aged patients; Aged, 80 and over; Area Under Curve; Canada; Care and treatment; CAT scans; Chi-Square Distribution; Clinical outcomes; Coma; CT imaging; Decision Support Techniques; Disability Evaluation; Elderly patients; Female; Functional status; Health aspects; Humans; Leukoaraiosis - diagnostic imaging; Living alone; Logistic Models; Male; Middle Aged; Multivariate Analysis; Nervous system diseases; Neurologic Examination; Nova Scotia; Older people; Operators; Predictive Value of Tests; Prognosis; Recovery of Function; Reproducibility of Results; Risk Assessment; Risk Factors; Severity of Illness Index; Single Person; Stroke; Stroke - diagnosis; Stroke - diagnostic imaging; Stroke - physiopathology; Stroke - therapy; Strokes; Time Factors; Tomography, X-Ray Computed
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afs034

models to predict functional status post-stroke have utility in balancing groups in randomised trials, for outcome comparison between stroke centres and may assist in outcome prediction. This study aimed to develop models of both excellent [modified Rankin score (mRS) 0-1] and devastating outcomes (mRS of 5-6). patients admitted with ischaemic or haemorrhagic stroke in 2001-02 to the Halifax Infirmary, Canada, were enrolled. Sixteen clinical variables from the first neurological assessment and six radiological variables from the acute CT scan were used to the model outcome at 6 months. five hundred and thirty-eight stroke patients were enrolled. Thirty per cent had an excellent outcome and 30% had a devastating outcome. Three models of the excellent outcome were developed [area under the receiver operator curve (AUC) 0.866-882] including the variables age, pre-stroke functional status, stroke severity, ability to lift both arms, walk independently, normal verbal Glasgow Coma Scale and leukoaraiosis. Predictive models of the devastating outcome (AUC of 0.859-0.874) included additional variables living alone pre-stroke and total anterior circulation stroke. The simplest models of both outcomes were externally validated (AUC of 0.856-0.885). this study demonstrates new externally validated predictive models of both excellent and devastating outcomes. Leukoaraiosis was the only independent radiological predictor of both outcomes. Living alone pre-stroke predicted devastating outcome post-stroke.