title: Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
abstract: BACKGROUND
  To assess the utility of previously developed scoring systems, we compared SEDAN, named after the components of the score (baseline blood Sugar, Early infarct signs and (hyper) Dense cerebral artery sign on admission computed tomography scan, Age, and National Institutes of Health Stroke Scale on admission), Totaled Health Risks in Vascular Events (THRIVE), Houston Intra-arterial Therapy (HIAT), and HIAT-2 scoring systems among patients receiving systemic (intravenous [IV] tissue plasminogen activator [tPA]) and endovascular (intra-arterial [IA]) treatments.
  
  
  METHODS
  We retrospectively reviewed all IV tPA and IA patients presenting to our center from 2008-2011. The scores were assessed in patients who were treated with IV tPA only, IA only, and a combination of IV tPA and IA (IV-IA). We tested the ability of THRIVE to predict discharge modified Rankin scale (mRS) 3-6, HIAT and HIAT-2 discharge mRS 4-6, and SEDAN symptomatic intracerebral hemorrhage (sICH).
  
  
  RESULTS
  Of the 366 patients who were included in this study, 243 had IV tPA only, 89 had IA only, and 34 had IV-IA. THRIVE was predictive of mRS 3-6 in the IV-IA (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.30-2.91) and the IV group (OR, 1.71; 95% CI, 1.43-2.04), but not in the IA group. HIAT was predictive of mRS 4-6 in the IA (OR, 3.55; 95% CI, 1.65-7.25), IV (OR, 3.47; 95% CI, 2.26-5.33), and IV-IA group (OR, 6.48; 95% CI, 1.41-29.71). HIAT-2 was predictive of mRS 4-6 in the IA (OR, 1.39; 95% CI, 1.03-1.87) and IV group (OR, 1.36; 95% CI, 1.18-1.57), but not in the IV-IA group. SEDAN was not predictive of sICH in the IA or the IV-IA group, but was predictive in the IV group (OR, 1.54; 95% CI, 1.01-2.36).
  
  
  CONCLUSIONS
  Our study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham. Electronic address: akboehme@gmail.com.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham.
authors.forename: Pawan V
authors.initials: PV
authors.lastname: Rawal
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham; Stroke Center, Birmingham Veterans Affairs Medical Center.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lyerly
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE); Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC).
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham.
authors.forename: Reza
authors.initials: R
authors.lastname: Bavarsad Shahripour
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham.
authors.forename: Paola
authors.initials: P
authors.lastname: Palazzo
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham.
authors.forename: Niren
authors.initials: N
authors.lastname: Kapoor
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alvi
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham.
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Houston
authors.affiliation: Department of Neurosurgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Harrigan
authors.affiliation: Department of Neurosurgery, University of Colorado, Denver, Colorado.
authors.forename: Luis
authors.initials: L
authors.lastname: Cava
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham.
authors.forename: April
authors.initials: A
authors.lastname: Sisson
authors.affiliation: School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Alexandrov
authors.affiliation: Stroke Center, Department of Neurology, University of Alabama at Birmingham.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002545:Brain Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D003661:Decision Support Techniques; D017128:Embolectomy / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D001786:Blood Glucose; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Stroke; epidemiology; outcome; stroke recovery
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