title: Stroke Severity Score based on Six Signs and Symptoms The 6S Score: A Simple Tool for Assessing Stroke Severity and In-hospital Mortality.
abstract: OBJECTIVE
  Ascertaining stroke severity and predicting risk of in-hospital mortality is crucial to advise patients and families about medical decisions. We developed and tested the validity of a new stroke score, the 6S Score (Stroke Severity Score based on Six Signs and Symptoms), for quantifying ischemic stroke severity and predicting in-hospital mortality.
  
  
  METHODS
  We prospectively assessed 210 consecutive acute ischemic stroke patients. The cohort was further divided into a derivation (n=120) and a validation (n=90) sample. From a total of 10 stroke signs and symptoms, we selected those with likelihood ratio's P<0.005. We tested the validity of the score for predicting in-hospital mortality by using receiver operating characteristic curves. We used a scatterplot and the Spearman's test to evaluate the correlation between the 6S Score and the National Institutes of Health Stroke Scale as a marker of stroke severity. We used principal component and exploratory factor analyses for assessing qualitative aspects of the 6S Score.
  
  
  RESULTS
  The C statistic for in-hospital mortality was 0.82 for the 6S Score and 0.86 for the National Institutes of health Stroke Scale, respectively, with no significant differences between each other (P=0.79). The correlation between both scores was strong (Spearman's rho 0.68, P<0.001). The factor analyses showed a good balance between left/right hemispheres and anterior/posterior circulations.
  
  
  CONCLUSIONS
  The 6S Score may constitute a tool for easily assessing stroke severity and predicting stroke mortality. Further research is needed for further assessing its external validity.
authors.affiliation: Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada.
authors.forename: Juan Manual
authors.initials: JM
authors.lastname: Racosta
authors.affiliation: Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Di Guglielmo
authors.affiliation: Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina.
authors.forename: Francisco Ricardo
authors.initials: FR
authors.lastname: Klein
authors.affiliation: Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada.
authors.forename: Patricia Mariana
authors.initials: PM
authors.lastname: Riccio
authors.affiliation: Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina.
authors.forename: Francisco Muñoz
authors.initials: FM
authors.lastname: Giacomelli
authors.affiliation: Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina.
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: González Toledo
authors.affiliation: Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina.
authors.forename: Fátima
authors.initials: F
authors.lastname: Pagani Cassará
authors.affiliation: Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina.
authors.forename: Agustina
authors.initials: A
authors.lastname: Tamargo
authors.affiliation: Stroke Center. Favaloro Foundation University Hospital, Favaloro University, Buenos Aires, Argentina.
authors.forename: Matías
authors.initials: M
authors.lastname: Delfitto
authors.affiliation: Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada.
authors.forename: Luciano Alberto
authors.initials: LA
authors.lastname: Sposato
keywords: Complications; Mortality; Score; Stroke