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13-02-2012 | Stroke | Article

Novel score predicts long-term thrombolysis outcomes

Abstract

Free abstract

MedWire News: Researchers have developed a tool, named the DRAGON score, to predict patients' outcomes after undergoing intravenous thrombolysis for acute ischemic stroke.

"The DRAGON score is simple and fast to perform, it has no cost, and it consists solely of factors that are known when the patient is admitted to the hospital or soon after," said lead researcher Daniel Strbian (Helsinki University Central Hospital, Finland) in a press statement.

The score has a range of 0-10 points, awarded according to patients' age, baseline glucose level, and National Institutes of Health Stroke Scale score; whether patients have a hyperdense artery sign or early infarct signs on admission computed tomography and whether they have prestroke disability; and the onset-to-treatment time.

"We found that we could determine the score in less than a minute," said Strbian. The DRAGON score was derived in a cohort of 1319 stroke patients who underwent thrombolysis in Helsinki University Central Hospital, in whom the score had good discriminatory power as assessed by area under the receiver operating characteristic curve analysis. As the DRAGON score increased, the proportion of patients with good 3-month outcomes (modified Rankin Scale [mRS] 0-2) fell and the proportion with very poor outcomes (mRS 5-6) rose.

For example, 96% of patients with a DRAGON score of 0-1 had good outcomes, as did 74% of those with a score of 3 and none of those with scores of 8-10. Conversely, the proportions of patients with very poor outcomes were 0%, 70%, and 100% for scores of 0-1, 8, and 9-10, respectively.

The ability to predict poor outcomes despite intravenous thrombolysis "can lead to rapid arrangements for invasive add-on treatment strategies such as endovascular treatment or hypothermia," Strbian et al comment in Neurology.

The team validated the score in an additional 330 patients treated in University Hospital Basel, Switzerland. The discriminatory ability of the score in these patients was not statistically different from that in the derivation cohort. This was despite several important differences between the cohorts, with the validation cohort generally being older, with more severe strokes than the derivation cohort, and more often having poor outcomes.

The researchers add that the heterogeneity between the derivation and validation cohorts suggests that the DRAGON score may prove to be generalizable, but caution that it should undergo additional testing in other cohorts.

By Eleanor McDermid

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