Beyeler et al reported the Occult-5 score to predict the risk of an occult malignancy in a stroke patient. This can help to identify a patient for whom a complete examination should be performed. The authors are from multiple institutions in Switzerland,
Patient selection: stroke
Parameters:
(1) age in years
(2) embolic stroke of unknown source (ESUS)
(3) multi-territory infarcts
(4) plasma D-dimer in µg/L
(5) sex
Parameter
Finding
Points
age in years
< 77 years
0
>= 77 years
1
ESUS
no
0
yes
1
multi-territory infarcts
no
0
yes
1
D-dimer
< 820 µg/L
0
>= 820 µg/L
1
sex
male
0
female
1
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• A score >= 3 has the highest Youden index (sensitivity 0.64, specificity 0.73).
Total Score
Posterior Probability Occult Malignancy
>= 0
2.2%
>= 1
2.2%
>= 2
3.3%
>= 3
5%
>= 4
6.4%
5
7.7%
Performance:
• The area under the ROC curve is 0.73.
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