Systematic review of prognostic models in patients with acute stroke

Prognostic models in stroke may be useful in clinical practice and research . We systematically reviewed the methodology and results of studies that ha ve identified independent predictors of survival, independence in activitie s of daily living, and getting home in patients, with acute stroke. Eligibl e studies (published in full in English) included at least 100 patients in whom at least 3 predictor variables were assessed within 30 days of stroke onset and who were followed up for at least 30 days. We recorded 25 indicat ors of the validity and practicality of each model and identified variables that were consistent independent predictors of each outcome. Eighty-three separate prognostic models were found but most had potentially serious defi ciencies in internal and statistical validity, many had limited generalisab ility, and none had been adequately validated. Only 4 studies met 8 simple quality criteria. Over 150 different predictor variables have been analysed but most were assessed in only 1 or 2 models. None of the existing prognos tic models have been sufficiently well developed and validated to be useful in either clinical practice or research. Better quality models must be pro duced to enable, for example, adequate case-mix correction when comparing o utcome among different groups of stroke patients. Copyright (C) 2001 S. Kar ger AG, Basel.