Validating and Comparing Stroke Prognosis Scales

Terence J Quinn, Sarjit Singh, Kennedy R. Lees, Philip M Bath, Phyo K Myint

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Abstract

Objective: We set out to compare the prognostic accuracy of various acute stroke prognostic scales using a large, independent, clinical trials dataset.
Methods: We directly compared eight stroke prognostic scales, chosen based on focussed literature review (ASTRAL, iSCORE, iSCORE-revised, PLAN, SOAR, SOAR-modified, SPI2 and THRIVE) using individual patient level data from a clinical trials archive (VISTA). We calculated area under ROC curves (AUROC) for each scale against 90-day outcomes of: modified Rankin Scale (dichotomized at mRS>2); Barthel Index (BI>85); and mortality. We performed two complementary analyses: the first limited to patients with complete data for all components of all scales (simultaneous) and the second used as many patients as possible for each individual scale (separate). We compared AUROCs and performed sensitivity analyses substituting extreme outcome values for missing data.
Results: In total 10,777 patients contributed to the analyses. Our simultaneous analyses suggested ASTRAL had greatest prognostic accuracy for mRS, AUROC:0.78 (95%CI:0.75-0.82) and SPI2 had poorest AUROC:0.61 (95%CI:0.57-0.66). Our separate analyses confirmed these results, ASTRAL AUROC:0.79 (95%CI:0.78-0.80 and SPI2 AUROC:0.60 (95%CI:0.59-0.61). On formal comparative testing, there was a significant difference in mRS AUROC between ASTRAL and all other scales. Sensitivity analysis identified no evidence of systematic bias from missing data.
Conclusions: Our comparative analyses confirm differences in the prognostic accuracy of stroke scales. However, even the best performing scale had prognostic accuracy that may not be sufficient as a basis for clinical decision making.
Original languageEnglish
Pages (from-to)997-1002
Number of pages7
JournalNeurology
Volume89
Issue number10
Early online date9 Aug 2017
DOIs
Publication statusPublished - 5 Sep 2017

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    Quinn, T. J., Singh, S., Lees, K. R., Bath, P. M., & Myint, P. K. (2017). Validating and Comparing Stroke Prognosis Scales. Neurology, 89(10), 997-1002. https://doi.org/10.1212/WNL.0000000000004332