Platzbecker et al reported a prognostic model for predicting the risk of ischemic stroke during the first year after surgery. The authors are from multiple institutions n the United States and Germany.
STRAS = stroke after surgery
Patient selection: surgery
Parameters:
(1) age in years
(2) sex
(3) race
(4) emergency surgery
(5) vascular surgery
(6) neurosurgery
(7) valvular heart disease
(8) hypertension
(9) migraine
(10) atrial fibrillation
(11) patent ductus arteriosus
(12) previous history of ischemic stroke or TIA
(13) number of months since previous stroke or TIA (if positive history)
(14) ischemic stroke or TIA diagnosed
(15) carotid artery stenosis
(16) ASA physical status
|
Parameter |
Finding |
Points |
|
age in years |
<= 40 years |
0 |
|
|
41 to 50 years |
2 |
|
|
51 to 70 years |
4 |
|
|
> 70 years |
6 |
|
sex |
female |
0 |
|
|
male |
1 |
|
race |
Black |
2 |
|
|
other |
0 |
|
emergency surgery |
no |
0 |
|
|
yes |
2 |
|
vascular surgery |
no |
0 |
|
|
yes |
3 |
|
neurosurgery |
no |
0 |
|
|
yes |
7 |
|
valvular heart disease |
no |
0 |
|
|
yes |
1 |
|
hypertension |
no |
0 |
|
|
yes |
1 |
|
migraine |
no |
0 |
|
|
yes |
2 |
|
atrial fibrillation |
no |
0 |
|
|
yes |
3 |
|
patent foramen ovale |
no |
0 |
|
|
yes |
5 |
|
Parameter |
Finding |
No Previous History |
Previous History <= 3 months |
Previous History > 3 months |
|
carotid stenosis |
no |
0 |
0 |
0 |
|
|
yes |
6 |
3 |
3 |
|
ASA |
<= 2 |
0 |
0 |
0 |
|
|
>= 3 |
4 |
1 |
0 |
|
dx stroke/TIA |
no |
0 |
0 |
0 |
|
|
yes |
0 |
19 |
12 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 62 (theoretical)
• The higher the score the greater the risk of stroke in the year following surgery.
|
Score |
Probability |
|
0 |
0.2% |
|
5 |
0.4% |
|
10 |
1.2% |
|
15 |
3.2% |
|
20 |
8.3% |
|
25 |
19.9% |
|
30 |
40.8% |
For a score for 0 to 30:
1-year probability of stroke =
= (0.00003111 * ((score)^3)) - (0.0006205 * ((score)^2)) + (0.004163 * (score)) - 0.00007143
