Strbian et al reported the DRAGON score for predicting outcome following intravenous thrombolytic therapy for ischemic stroke. The authors are from Helsinki University Central Hospital.
Patient selection: status post intravenous thrombolytic therapy (using alteplase) for ischemic stroke. The study did not include patients with basilar artery occlusion.
Outcome: functional status at 3 months (good if modified Rankin scale 0 or 2, miserable if modified Rankin scale 5 or 6))
Parameters:
(1) D for dense or hyperdense cerebral artery sign OR early infarct signs on admission CT head scan
(2) R for modified Rankin status, prestroke
(3) A for age in years
(4) G for glucose (glucose) on admission in mmol/L
(5) O for onset-to-treatment time in minutes
(6) N for NIHSS score on admission
|
Parameters |
Findings |
Points |
|---|---|---|
|
dense or hyperdense MCA sign |
absent |
0 |
|
|
present |
1 |
|
early infarct signs |
absent |
0 |
|
|
present |
1 |
|
mRS score prestroke |
<= 1 |
0 |
|
|
> 1 |
1 |
|
age in years |
< 65 years of age |
0 |
|
|
65 to 79 years of age |
1 |
|
|
>= 80 years of age |
2 |
|
glucose on admission |
<= 8 mmol/L (<=144 mg/dL) |
0 |
|
|
> 8 mmol/L (> 144 mg/dL) |
1 |
|
onset to treatment time |
<= 90 minutes |
0 |
|
|
> 90 minutes |
1 |
|
NIHSS on admission |
<= 4 |
0 |
|
|
5 to 9 |
1 |
|
|
10 to 15 |
2 |
|
|
>= 16 |
3 |
where:
• Early infarct signs include: hypoattenuation comprising less than one third of the middle cerebral artery territory, obscuratio of the lentiform nucleus, loss of basal ganglion outline, loss of insular ribbon, obscuration of the Sylvian fissure, or cortical sulcal effacement.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score 10
|
Score |
Good Outcome |
Miserable Outcome |
|---|---|---|
|
0-1 |
96% |
0% |
|
2 |
88% |
2% |
|
3 |
74% |
5% |
|
8 |
0% |
70% |
|
9 to 10 |
0% |
100% |
Performance:
• The area under the ROC curve was 0.80 to 0.84.
Specialty: Neurology
