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.
Specialty: Neurology, Emergency Medicine