The Acute Stroke Registry and Analysis of Lausanne (ASTRAL) developed a score to predict functional outcome after an acute ischemic stroke. This can help to distinguish patients with different prognosis and clinical needs. The authors are from the University of Lausanne, University of Thessaly, St. John’s of God Hospital in Vienna and Alexandra Hospital in Athens.
Outcome: modified Rankin score > 2 (excluding anyone with a prestroke modified Ranksin score > 2)
Parameters:
(1) age
(2) NIHSS score (as measure of stroke severity, maximum score 36) in the Emergency Room
(3) time from onset to hospital admission
(4) visual field defect
(5) serum glucose
(6) level of consciousness
Parameter |
Finding |
Points |
age in years |
|
INT((age) / 5) |
NIHSS |
|
(NIHSS score) |
time delay from onset |
<= 3 hours |
0 |
|
> 3 hours |
2 |
visual field defect |
none |
0 |
|
present (hemianopia or quadranopsia) |
2 |
serum glucose |
< 3.7 mmol/L |
1 |
|
3.7 to 7.3 mmol/L |
0 |
|
> 7.3 mmol/L |
1 |
level of consciousness |
normal |
0 |
|
decreased |
3 |
where:
• There are several ways to handle the age variable. Since this is an integer score the INTEGER function was opted for here. ROUND could also be used.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: around 69 (assuming advanced age, items 3 to 6 add up to 8)
• The higher the score the worse the outcome. A score of 31 was associated with a 50% chance of a modified Rankin score > 2.
If the data in Figure 1 is analyzed:
X =
= (0.1838 * (score)) – 5.587
probability of an unfavorable outcome =
= 1 / (1 + EXP((-1) * X))
Specialty: Neurology
ICD-10: ,