Gattringer et al reported a score (PREMISE score) for predicting early mortality in a patient with an acute ischemic stroke. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Austria and the Austrian Stroke Unit Registry Collaborators.
Patient selection: acute ischemic stroke
Outcome: early death (<= 7 days post-stroke)
Parameters:
(1) age in years
(2) pre-existing disability
(3) NIHSS stroke severity (presumably the 1999 modification, scores from 0 to 42)
(4) diabetes mellitus
(5) heart disease (coronary artery disease, heart failure, cardiomyopathy, valve disease)
(6) posterior circulation stroke syndrome
(7) nonlacunar stroke
|
Parameter
|
Finding
|
Points
|
|
age of the patient
|
< 60 years
|
0
|
|
|
60 to 69 years
|
1
|
|
|
>= 70 years
|
2
|
|
pre-existing disability
|
modified Rankin 1 to 5
|
1
|
|
|
modified Rankin 0
|
0
|
|
NIHSS stroke severity
|
< 5
|
0
|
|
|
5 to 11
|
2
|
|
|
12 to 23
|
4
|
|
|
>= 24
|
5
|
|
diabetes mellitus
|
absent
|
0
|
|
|
present
|
1
|
|
heart disease
|
absent
|
0
|
|
|
present
|
1
|
|
posterior circulation stroke
|
absent
|
0
|
|
|
present
|
1
|
|
nonlacunar stroke
|
absent
|
0
|
|
|
present
|
1
|
where:
• The Rankin scale goes from 1 to 5, with 1 indicating no disability. The modified Rankin scale used goes from 0 to 5.
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the worse the survival.
|
Score
|
Early Mortality
|
|
0
|
0%
|
|
1
|
0.1%
|
|
2
|
0.2%
|
|
3
|
0.5%
|
|
4
|
1.4%
|
|
5
|
4%
|
|
6
|
8%
|
|
7
|
11%
|
|
8
|
19%
|
|
9
|
22%
|
|
10-12
|
35%
|
Performance:
• The area under the ROC curve is 0.88.
