Predicting Stroke Outcome Using Clinical-versus Imaging-based Scoring System
- Authors
- Baek, Joon Hyun; Kim, Kitae; Lee, Yeong-Bae; Park, Kee-Hyung; Park, Hyeon-Mi; Shin, Dong-Jin; Sung, Young Hee; Shin, Dong Hoon; Bang, Oh Young
- Issue Date
- Mar-2015
- Publisher
- ELSEVIER SCIENCE BV
- Keywords
- Cerebral infarct; outcomes; thrombolysis; ASPECTS score; DRAGON score; prognosis
- Citation
- JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, v.24, no.3, pp.642 - 648
- Journal Title
- JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
- Volume
- 24
- Number
- 3
- Start Page
- 642
- End Page
- 648
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/10772
- DOI
- 10.1016/j.jstrokecerebrovasdis.2014.10.009
- ISSN
- 1052-3057
- Abstract
- Background: Several models to predict outcome in ischemic stroke patients receiving intravenous (i.v.) alteplase can be divided into clinical-based and imaging-based systems. Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) and Dense cerebral artery sign/early infarct signs on admission CT scan, prestroke modified Rankin Scale (mRS) score, Age, Glucose level at baseline, Onset-to-treatment time, and baseline National Institutes of Health Stroke Scale score (DRAGON) are typical imaging-and clinical-based scoring systems, respectively. Therefore, we compared predictability of stroke outcome of clinical (DRAGON)- and imaging (ASPECTS)- based scoring systems. Methods: We analyzed patients who were diagnosed with middle cerebral artery territory stroke and treated with i.v. alteplase at Gachon University Gil Hospital over 5 years and compared performance of 2 scoring systems for prediction of good functional outcome (mRS, 0-2) with Pearson correlation and area under the curve-receiver operating characteristic (AUC-ROC). In addition, we analyzed predicting power of several clinical factors and 2 scoring systems by multiple regression analysis. Results: Study population (N - 120) had mean age of 66.2 +/- 13.2 years. ASPECTS (r = -.841, P < .0001) and DRAGON (r = .657, P < .0001) were significantly correlated with good functional outcome. In addition, statistical comparisons suggested that ASPECTS (AUC-ROC,.972; 95% confidence interval [CI],.947-.996) is significantly superior to DRAGON (AUC-ROC,.854; 95% CI,.786-.922) in predicting functional outcome (difference between areas,.118 +/- .0332; 95% CI,.0559-.180, P = .0002). Multiple regression analysis revealed that ASPECTS was the independent predictor of good prognosis (OR, 6.59 per 1-point increase; 95% CI, 2.35-18.49; P < .0001 and OR, 77.67 for ASPECTS >= 8; 95% CI, 14.30-421.79; P < .0001). Conclusions: ASPECTS is superior method for predicting functional outcome in acute ischemic stroke patients receiving i.v. alteplase compared with DRAGON and integration of ASPECTS score into clinical care pathway as decision-making tool can be reasonable.
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