Background Accurate assessment of prognosis in the first hours of stroke is
desirable for best patient management. We aimed to assess whether the exte
nt of ischaemic brain injury on magnetic resonance diffusion-weighted imagi
ng (MR DWI) could provide additional prognostic information to clinical fac
tors.
Methods In a three-phase study we studied 66 patients from a North American
teaching hospital who had: MR DWI within 36 hours of stroke onset; the Nat
ional Institutes of Health Stroke Scale (NIHSS) score measured at the time
of scanning; and the Barthel Index measured no later than 3 months after st
roke. We used logistic regression to derive a predictive model for good rec
overy. This logistic regression model was applied to an independent series
of 63 patients from an Australian teaching hospital, and we then developed
a three-item scale for the early prediction of stroke recovery.
Findings Combined measurements of the NIHSS score (p=0.01), time in hours f
rom stroke onset to MR DWI (p=0.02), and the volume of ischaemic brain tiss
ue on MR DWI (p=0.04) gave the best prediction of stroke recovery. The mode
l was externally validated on the Australian sample with 0.77 sensitivity a
nd 0.88 specificity. Three likelihood levels for stroke recovery-low (0-2),
medium (3-4), and high (5-7)-were identified on the three-item scale.
Interpretation The combination of clinical and MR DWI factors provided bett
er prediction of stroke recovery than any factor alone, shortly after admis
sion to hospital. This information was incorporated into a three-item scale
for clinical use.