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An integer-based score to
predict functional jr5in acute
ischemic strokeThe ASTRAL score
Neurology 78 June 12, 2012 1917
: To develop and validate a simple, integer-based score to predict functional outcome in
acute ischemic stroke (AIS) using variables readily available after emergency room admission.
Objective
stroke physicians in treatment realistic prognostic expectations and to
plan the long-term living setting. nonrandomized studies to control for case-
mix variation controlled clinical trials as a selection
criterion.
prediction of stroke outcome
Age (A), severity of stroke (S) measured by
admission NIH Stroke Scale score, Stroke onset to admission time (T), range of visual fields (R), acute glucose (A), level of consciousness(L)
ASTRAL SCORE
The prognostic score was developed in a cohort of patients from the Acute Stroke Registry: age, gender, onset to admission time, prestroke mRS score, the type of clinical deficit according to the NIH Stroke
Scale (NIHSS) score, the absolute NIHSS score at admission, vascular territory and localization of the stroke by TOAST cardiovascular risk factors and comorbidities, prestroke medication,
METHODS
cohortof patients from the Acute Stroke
Registry and Analysis of Lausanne
(ASTRAL).8
The derived prognostic score
was validatedexternally in 2 independent
cohorts from the Athens9 and
Vienna10Stroke Registries
For this analysis, we included all patientsadmitted between
January 1, 1998, and December 31,
2010 (Athens), and between October 10, 1998, and December
29, 2001 (Vienna).A logist
: age, gender, onset to admission Time , prestroke mRS score, the type of clinical deficit accordin gto the NIH Stroke
Scale (NIHSS) score , the absolute NIHSSscore at admission, vascular territord localization of the\\Treatment (TOAST) mechanism,11 cardiovascular risk
factors and comorbidities, prestroke medication, basic findings
on brain imaging at admission (noncontrast CT or T2 or
The following covariates wereincluded in the multivariate analysis
Covariates Score points Age: for every 5 ya 1 Severity: for every NIHSS pointa 1 Time delay from onset to admission >3
hb 2 Range of visual field defectc 2 Acute glucose >7.3 or <3.7 mmol/Ld
1 Level of consciousness decreasede 3
Six covariates were identified as independent
predictors of unfavorable outcome in multiple
logistic regression analysis: age, NIHSS score at ad-
mission, delay from stroke onset to admission, visual
field defect, glucose at admission, and impaired level of
consciousness
1,967 patients registered in the
,322 were excluded
mean NIHSS score at admission 8.0 7.8
The mean age was 68.2
42.8% were womens
RESULTS
The median score value was 23(range 5-63)
can be assessed in the emergency room to predict ischemic stroke
outcome that time to admission is an independent predictor of outcomeat 3
months in patients arriving within 24 hours
DISCUSSION
that time to admission is an independent predictor of outcome
that time to admission is an independent predictor of outcome
the ASTRAL score in its current form does not require information
from brain imaging (other than excluding
intracerebral hemorrhage, It was derived from a large registry of
consecutive patients and has performed well during external
validation in 2 independent large stroke registries
The use of the ASTRAL score as a selection criterion could help identify and recruit those patients who would have an increased likelihood of achieving a positive result; the rapid and easy (especially with the use of the color chart) calculation of the score at an early stage such as hospital
admission emphasizes the feasibility of use of the ASTRAL score as a selection tool for recruitment of patients in randomized clinical trials
Thank you