Objective: To compare the acute Alien's Prognostic Score, Canadian Neu
rological Score, and subacute Barthel Index as predictors of outcome f
unctional status and infarct size at 3 months in patients with acute c
ortical infarction. Design: A prospective study of acute stroke predic
tors and outcome measurements in a cohort of sequential hospitalized p
atients. Patients: Fifty-one patients with acute cortical infarction a
nd without previous disability assessed 24 hours after onset with Alie
n's Prognostic Score and the Canadian Neurological Score and at 7 days
with the Barthel Index. Main Outcome Measures: Mortality, Barthel Ind
ex, and volumetric measurement of infarct size on computed tomography
3 months after stroke. Results: There were seven deaths. The outcome B
arthel Index was measured in all 44 survivors, of whom 29 had computed
tomography at the time outcome was determined. In a multivariate anal
ysis, functional outcome was best predicted by Alien's Prognostic Scor
e, a score of less than -15 having a sensitivity of 82% and specificit
y of 97% in predicting a poor outcome (Barthel Index, less than or equ
al to 12 or death). Volumetric tissue loss was predicted only by Alien
's Prognostic Score (r=.62, P<.001). Conclusions: Alien's Prognostic S
core is a robust predictor of both functional outcome and tissue loss
in acute cortical infarction and has a potentially important role in t
he analysis of the results of acute stroke intervention trials.