PREDICTION OF LONG-TERM OUTCOME IN THE EARLY HOURS FOLLOWING ACUTE ISCHEMIC STROKE

Objective: To develop a model for predicting outcome in the first few hours after the onset of an ischemic stroke on the basis of the clinic al findings obtained during a rapid bedside examination. Design: Clini cal records were retrieved from the data bank of a randomized multicen ter trial. The resulting case series was split into two subgroups that served as a ''training set'' and a ''test set.'' Logistic regression was applied to the training set to select the prognostic predictors am ong baseline clinical findings, The performances of the model based on independent prognostic predictors were then validated in the test set . Setting: Eleven primary care institutions (either hospitals or unive rsity clinics) participating in the Italian Acute Stroke Study on the efficacy of hemodilution and monosialoganglioside in acute ischemic st roke. Patients: Consecutive noncomatose patients (N=300) observed with in the first 6 hours after the onset of a first supratentorial ischemi c stroke. Main Outcome Measure: Death or disablement 4 months after th e index stroke, Disablement was defined as a score of 3 or higher on t he Rankin Scale. Results: Age and CNS score defined six risk groups wi th a predicted 4-month poor outcome rate ranging from 10% (patients ag ed 70 years or younger and with an initial CNS score of 7 or higher) t o 89% (patients older than 70 years and with a CNS score of 4.5 or low er). When a risk of poor outcome of 60% was taken as a cutoff, the acc uracy of the prediction was 78%+/-6% in the training set and 72%+/-9% in the test set. Conclusion: Long-term outcome can be predicted in the first few hours following an acute ischemic stroke by means of a simp le model based on age and CNS score.