O'Donnell et al reported the PLAN score for evaluating a patient with acute ischemic stroke at the bedside. This can help to identify a patient at risk for a poor outcome. The authors are from the National University of Ireland, University of Toronto, Joseph Brant Hospital and Hamilton Health Sciences in Hamilton, Canada.
Patient selection: acute ischemic stroke
Outcomes: severe disability (modified Rankin score 5) or death (modified Rankin score 6)
PLAN is a mnemonic for Preadmission medical comorbidities, Level of consciousness, Age and Neurologic deficits.
Parameters:
(1) preadmission dependence
(2) cancer
(3) congestive heart failure
(4) atrial fibrillation
(5) level of consciousness
(6) age
(7) arm weakness
(8) leg weakness
(9) neglect or aphasia
Parameter
Finding
Points
preadmission dependence
no
0
yes
1.5
cancer
no
0
yes
1.5
congestive heart failure
no
0
yes
1
atrial fibrillation
no
0
yes
1
level of consciousness
not reduced
0
reduced
5
age
MIN(10,INT(age)/10))
arm weakness
none to mild
0
significant to severe
2
leg weakness
none to mild
0
significant to severe
2
neglect or aphasia
absent
0
present
1
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 25
• The higher the score the worse the outcome.
PLAN Score
30-day Mortality (from admission)
Severe Dependence or Mortality at Discharge
0 to 5
1%
1%
6 to 9
3%
3%
10 to 12
8%
10%
13 to 15
21%
29%
16 to 19
38%
59%
20 to 25
65%
77%
from Figures 2 and 4
Performance:
• The area under the ROC curve was 0.86 for 30-day mortality. It was 0.88 for severe disability or death at discharge.
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