title: Simple variables predict miserable outcome after intravenous thrombolysis.
abstract: OBJECTIVE
  To test the predictability of miserable outcome amongst ischaemic stroke patients receiving intravenous thrombolysis (IVT) based on a simple variables model (SVM) and to compare the model's predictive performance with that of an existing score which includes imaging and laboratory parameters (DRAGON).
  
  
  METHODS
  The SVM consists of the parameters age, independence before stroke, normal Glasgow coma verbal score, able to lift arms and able to walk. In a derivation cohort (n = 1346) and a validation cohort (n = 638) of consecutive IVT-treated stroke patients, the probability estimated by SVM and the observed occurrence of miserable 3-month outcome (modified Rankin score 5-6) were compared. The performances of SVM and the DRAGON score were compared. The area under the receiver operating curve (AUC) (95% confidence interval, CI) and the bootstrapping approach were used to compare the predictive performance.
  
  
  RESULTS
  The AUCs to predict miserable outcome in the derivation cohort were 0.807 (95% CI 0.774-0.838) using the SVM and 0.822 (0.790-0.850) using the DRAGON score (P = 0.3). For the validation cohort, AUCs were 0.786 (0.742-0.829) for the SVM and 0.809 (0.774-0.845) for the DRAGON score (P = 0.23). Only one patient with an SVM probability of >70% for miserable outcome in either cohort had a good outcome whilst 83% had a miserable outcome. An online SVM calculator to estimate the probability of miserable outcome for individual patients is available under http://www.unispital-basel.ch/SVM-Tool.
  
  
  CONCLUSIONS
  The SVM was similar in accuracy to the DRAGON score for predicting miserable outcome after IVT. As these simple variables are available already at the pre-hospital stage, the SVM may facilitate and accelerate pre-hospital triage of patients at high risk for miserable outcome after IVT towards endovascular treatment.
authors.affiliation: Department of Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: D J
authors.initials: DJ
authors.lastname: Seiffge
authors.forename: A
authors.initials: A
authors.lastname: Karagiannis
authors.forename: D
authors.initials: D
authors.lastname: Strbian
authors.forename: H
authors.initials: H
authors.lastname: Gensicke
authors.forename: N
authors.initials: N
authors.lastname: Peters
authors.forename: L H
authors.initials: LH
authors.lastname: Bonati
authors.forename: K
authors.initials: K
authors.lastname: Kotisaari
authors.forename: M
authors.initials: M
authors.lastname: Leppä
authors.forename: J
authors.initials: J
authors.lastname: Kejda-Scharler
authors.forename: C
authors.initials: C
authors.lastname: Tränka
authors.forename: P
authors.initials: P
authors.lastname: Ginsbach
authors.forename: T
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: P A
authors.initials: PA
authors.lastname: Lyrer
authors.forename: S T
authors.initials: ST
authors.lastname: Engelter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: intravenous thrombolysis (IVT); outcome prediction; prognosis; stroke