title: The SOAR (Stroke subtype, Oxford Community Stroke Project classification, Age, prestroke modified Rankin) score strongly predicts early outcomes in acute stroke.
abstract: BACKGROUND
  Previous prognostic scoring systems in predicting stroke mortality are complex, require multiple measures that vary with time and failed to produce a simple scoring system.
  
  
  OBJECTIVE
  The study aims to derive and internally validate a stroke prognostic scoring system to predict early mortality and hospital length of stay.
  
  
  METHODS
  Data from a U.K. multicenter stroke register were examined (1997-2010). Using a prior hypothesis based on our and others observations, we selected five patient-related factors (age, gender, stroke subtype, clinical classification, and prestroke disability) as candidate prognostic indicators. An 8-point score was derived based on multiple logistic regression model using four out of five variables. Performance of the model was assessed by plotting the estimated probability of in-hospital death against the actual probability by testing for overfitting (calibration) and area under the curve methods (discrimination).
  
  
  RESULTS
  The total sample consisted of 12,355 acute stroke patients (ischemic stroke 91.0%). The score predicted both in-patient and seven-day mortality. The crude in-patient mortality were 1.57%, 4.02%, 10.65%, 21.41%, 46.60%, 62.72%, and 75.81% for those who scored 0, 1, 2, 3, 4, 5, and 6, respectively. The calibration of the model revealed no evidence of overfitting (estimated overfitting 0.001). The area under the curve values for both in-hospital and seven-day mortality were 0.79. The score predicted length of stay with a higher score was associated with longer median length of stay in those discharged alive and shorter median length of stay in those who died (P for both <0.001).
  
  
  CONCLUSIONS
  A simple 8-point clinical score is highly predictive of acute stroke mortality and length of hospital stay. It could be used as prognostic tool in service planning and also to risk-stratify patients to use these outcomes as markers of stroke care quality across institutions.
authors.affiliation: Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK; Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK; Clinical Gerontology Unit, University of Cambridge, Cambridge, Cambridgeshire, UK.
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
authors.forename: Allan B
authors.initials: AB
authors.lastname: Clark
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.forename: John
authors.initials: J
authors.lastname: Davis
authors.forename: Ramesh
authors.initials: R
authors.lastname: Durairaj
authors.forename: Anand K
authors.initials: AK
authors.lastname: Dixit
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sharma
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ford
authors.forename: John F
authors.initials: JF
authors.lastname: Potter
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012111:Residence Characteristics; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006113:United Kingdom
keywords: cardiovascular disease; length of stay; mortality; prognosis; prognosis score; stroke