Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke

Azmil H. Abdul-Rahim, Terence J. Quinn, Sarah Alder, Allan B. Clark, Stanley D. Musgrave, Peter Langhorne, John F. Potter, Phyo Kyaw Myint

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE: The stroke subtype, Oxfordshire Community Stroke Project classification, age, and prestroke modified Rankin (SOAR) score is a prognostic scale proposed for early mortality prediction after acute stroke. We aimed to evaluate whether including a measure of initial stroke severity (National Institutes of Health Stroke Scale and modified-SOAR [mSOAR] scores) would improve the prognostic accuracy.

METHODS: Using Anglia Stroke and Heart Clinical Network data, 2008 to 2011, we assessed the performance of SOAR and mSOAR against in-hospital mortality using area under the receiver operating curve statistics. We externally validated the prognostic utility of SOAR and mSOAR using an independent cohort data set from Glasgow. We described calibration using Hosmer-Lemeshow goodness-of-fit test.

RESULTS: A total of 1002 patients were included in the derivation cohort, and 105 (10.5%) died as inpatients. The area under the receiver operating curves for outcome of early mortality derived from the SOAR and mSOAR scores were 0.79 (95% confidence interval, 0.75-0.84) and 0.83 (95% confidence interval, 0.79-0.86), respectively (P=0.001). The external validation data set contained 1012 patients with stroke; of which, 121 (12.0%) patients died within 90 days. The mSOAR scores identified the risk of early mortality ranging from 3% to 42%. External validation of mSOAR score yielded an area under the receiver operating curve of 0.84 (95% confidence interval, 0.82-0.88) for outcome of early mortality. Calibration was good (P=0.70 for the Hosmer-Lemeshow test).

CONCLUSIONS: Adding National Institutes of Health Stroke Scale data to create a modified-SOAR score improved prognostic utility in both derivation and validation data sets. The mSOAR may have clinical utility by using easily available data to predict mortality.

Original languageEnglish
Pages (from-to)74-79
Number of pages6
JournalStroke
Volume47
Issue number1
Early online date17 Nov 2015
DOIs
Publication statusPublished - Jan 2016
EventEuropean Stroke Organisation Conference - Glasgow, United Kingdom
Duration: 17 Apr 201519 Apr 2015

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Stroke
Mortality
National Institutes of Health (U.S.)
Confidence Intervals
Calibration
Hospital Mortality
Inpatients
Datasets

Keywords

  • calibration
  • inpatients
  • mortality
  • prognosis
  • stroke

Cite this

Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke. / Abdul-Rahim, Azmil H.; Quinn, Terence J.; Alder, Sarah; Clark, Allan B.; Musgrave, Stanley D.; Langhorne, Peter; Potter, John F.; Myint, Phyo Kyaw.

In: Stroke, Vol. 47, No. 1, 01.2016, p. 74-79.

Research output: Contribution to journalArticle

Abdul-Rahim, Azmil H. ; Quinn, Terence J. ; Alder, Sarah ; Clark, Allan B. ; Musgrave, Stanley D. ; Langhorne, Peter ; Potter, John F. ; Myint, Phyo Kyaw. / Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke. In: Stroke. 2016 ; Vol. 47, No. 1. pp. 74-79.
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abstract = "BACKGROUND AND PURPOSE: The stroke subtype, Oxfordshire Community Stroke Project classification, age, and prestroke modified Rankin (SOAR) score is a prognostic scale proposed for early mortality prediction after acute stroke. We aimed to evaluate whether including a measure of initial stroke severity (National Institutes of Health Stroke Scale and modified-SOAR [mSOAR] scores) would improve the prognostic accuracy.METHODS: Using Anglia Stroke and Heart Clinical Network data, 2008 to 2011, we assessed the performance of SOAR and mSOAR against in-hospital mortality using area under the receiver operating curve statistics. We externally validated the prognostic utility of SOAR and mSOAR using an independent cohort data set from Glasgow. We described calibration using Hosmer-Lemeshow goodness-of-fit test.RESULTS: A total of 1002 patients were included in the derivation cohort, and 105 (10.5{\%}) died as inpatients. The area under the receiver operating curves for outcome of early mortality derived from the SOAR and mSOAR scores were 0.79 (95{\%} confidence interval, 0.75-0.84) and 0.83 (95{\%} confidence interval, 0.79-0.86), respectively (P=0.001). The external validation data set contained 1012 patients with stroke; of which, 121 (12.0{\%}) patients died within 90 days. The mSOAR scores identified the risk of early mortality ranging from 3{\%} to 42{\%}. External validation of mSOAR score yielded an area under the receiver operating curve of 0.84 (95{\%} confidence interval, 0.82-0.88) for outcome of early mortality. Calibration was good (P=0.70 for the Hosmer-Lemeshow test).CONCLUSIONS: Adding National Institutes of Health Stroke Scale data to create a modified-SOAR score improved prognostic utility in both derivation and validation data sets. The mSOAR may have clinical utility by using easily available data to predict mortality.",
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note = "We thank all who were involved in the Anglia Stroke and Heart Clinical Network data. Dr Myint supervised the project. Drs Abdul-Rahim, Alder, and Clark conducted the analyses. Drs Abdul-Rahim and Quinn drafted the initial article. Drs Abdul-Rahim, Quinn, Clark, and Myint involved in reviewing and reporting of the work. All authors provided critical revision of the article for important intellectual content and approved the final version.",
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T1 - Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke

AU - Abdul-Rahim, Azmil H.

AU - Quinn, Terence J.

AU - Alder, Sarah

AU - Clark, Allan B.

AU - Musgrave, Stanley D.

AU - Langhorne, Peter

AU - Potter, John F.

AU - Myint, Phyo Kyaw

N1 - We thank all who were involved in the Anglia Stroke and Heart Clinical Network data. Dr Myint supervised the project. Drs Abdul-Rahim, Alder, and Clark conducted the analyses. Drs Abdul-Rahim and Quinn drafted the initial article. Drs Abdul-Rahim, Quinn, Clark, and Myint involved in reviewing and reporting of the work. All authors provided critical revision of the article for important intellectual content and approved the final version.

PY - 2016/1

Y1 - 2016/1

N2 - BACKGROUND AND PURPOSE: The stroke subtype, Oxfordshire Community Stroke Project classification, age, and prestroke modified Rankin (SOAR) score is a prognostic scale proposed for early mortality prediction after acute stroke. We aimed to evaluate whether including a measure of initial stroke severity (National Institutes of Health Stroke Scale and modified-SOAR [mSOAR] scores) would improve the prognostic accuracy.METHODS: Using Anglia Stroke and Heart Clinical Network data, 2008 to 2011, we assessed the performance of SOAR and mSOAR against in-hospital mortality using area under the receiver operating curve statistics. We externally validated the prognostic utility of SOAR and mSOAR using an independent cohort data set from Glasgow. We described calibration using Hosmer-Lemeshow goodness-of-fit test.RESULTS: A total of 1002 patients were included in the derivation cohort, and 105 (10.5%) died as inpatients. The area under the receiver operating curves for outcome of early mortality derived from the SOAR and mSOAR scores were 0.79 (95% confidence interval, 0.75-0.84) and 0.83 (95% confidence interval, 0.79-0.86), respectively (P=0.001). The external validation data set contained 1012 patients with stroke; of which, 121 (12.0%) patients died within 90 days. The mSOAR scores identified the risk of early mortality ranging from 3% to 42%. External validation of mSOAR score yielded an area under the receiver operating curve of 0.84 (95% confidence interval, 0.82-0.88) for outcome of early mortality. Calibration was good (P=0.70 for the Hosmer-Lemeshow test).CONCLUSIONS: Adding National Institutes of Health Stroke Scale data to create a modified-SOAR score improved prognostic utility in both derivation and validation data sets. The mSOAR may have clinical utility by using easily available data to predict mortality.

AB - BACKGROUND AND PURPOSE: The stroke subtype, Oxfordshire Community Stroke Project classification, age, and prestroke modified Rankin (SOAR) score is a prognostic scale proposed for early mortality prediction after acute stroke. We aimed to evaluate whether including a measure of initial stroke severity (National Institutes of Health Stroke Scale and modified-SOAR [mSOAR] scores) would improve the prognostic accuracy.METHODS: Using Anglia Stroke and Heart Clinical Network data, 2008 to 2011, we assessed the performance of SOAR and mSOAR against in-hospital mortality using area under the receiver operating curve statistics. We externally validated the prognostic utility of SOAR and mSOAR using an independent cohort data set from Glasgow. We described calibration using Hosmer-Lemeshow goodness-of-fit test.RESULTS: A total of 1002 patients were included in the derivation cohort, and 105 (10.5%) died as inpatients. The area under the receiver operating curves for outcome of early mortality derived from the SOAR and mSOAR scores were 0.79 (95% confidence interval, 0.75-0.84) and 0.83 (95% confidence interval, 0.79-0.86), respectively (P=0.001). The external validation data set contained 1012 patients with stroke; of which, 121 (12.0%) patients died within 90 days. The mSOAR scores identified the risk of early mortality ranging from 3% to 42%. External validation of mSOAR score yielded an area under the receiver operating curve of 0.84 (95% confidence interval, 0.82-0.88) for outcome of early mortality. Calibration was good (P=0.70 for the Hosmer-Lemeshow test).CONCLUSIONS: Adding National Institutes of Health Stroke Scale data to create a modified-SOAR score improved prognostic utility in both derivation and validation data sets. The mSOAR may have clinical utility by using easily available data to predict mortality.

KW - calibration

KW - inpatients

KW - mortality

KW - prognosis

KW - stroke

U2 - 10.1161/STROKEAHA.115.009898

DO - 10.1161/STROKEAHA.115.009898

M3 - Article

C2 - 26578661

VL - 47

SP - 74

EP - 79

JO - Stroke

JF - Stroke

SN - 0039-2499

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ER -