title: A 5-item scale to predict stroke outcome after cortical middle cerebral artery territory infarction: validation from results of the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) Study.
abstract: OBJECTIVE
  Various clinical, laboratory, and radiographic parameters have been identified as predictors of outcome for ischemic stroke. The purpose of this study was to combine these parameters into a validated scale for outcome prognostication in patients with a middle cerebral artery territory infarction.
  
  
  METHODS
  We retrospectively reviewed 129 patients over a 2-year period and considered demographic, clinical, laboratory, and radiographic parameters as potential predictors of outcome. Inclusion criteria were unilateral hemispheric infarcts within the middle cerebral artery territory >15 mm in diameter. Our primary outcome measure was a favorable recovery defined as a modified Rankin Score was ≤2 at 30 days. A multivariable model was used to determine independent predictors of outcome and weighted to create a 5-item scale to predict stroke recovery. External validation of this model was done using data from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) study.
  
  
  RESULTS
  The 5 independent predictors of outcome were as follows: age (OR, 1.09; 95% CI, 1.03 to 1.14; P=0.001), National Institutes of Health Stroke Scale score (OR, 1.17; 95% CI, 1.06 to 1.30; P=0.003), infarct volume (OR, 1.01; 95% CI, 1.00 to 1.02; P=0.03), admission white blood cell count (8.5×10(3)/mm(3); OR, 1.16; 95% CI, 1.03 to 1.27; P=0.04), and presence of hyperglycemia (OR, 4.2; 95% CI, 1.1 to 16.4; P=0.04). Combining these variables into a point scale significantly improved prediction over the individual variables accounted alone as evidenced by the area underneath the receiver operating curve (OR, 0.91; 95% CI, 0.87 to 0.96; P=0.0001). When applied to the DEFUSE study population for validation, the model achieved a sensitivity of 83% and specificity of 86%.
  
  
  CONCLUSIONS
  With validation from a prospective study of similar patients, this model serves as a useful clinical and research tool to predict stroke recovery after cortical middle cerebral artery territory infarction.
authors.affiliation: Department of Neurology, St. Louis University, St. Louis, MO, USA.
authors.forename: Nirav A
authors.initials: NA
authors.lastname: Vora
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Shook
authors.forename: H Christian
authors.initials: HC
authors.lastname: Schumacher
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Tievsky
authors.forename: Greg W
authors.initials: GW
authors.lastname: Albers
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Wechsler
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome