title: Predicting stroke outcome using clinical- versus imaging-based scoring system.
abstract: BACKGROUND
  Several models to predict outcome in ischemic stroke patients receiving intravenous (i.v.) alteplase can be divided into clinical-based and imaging-based systems. Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) and Dense cerebral artery sign/early infarct signs on admission CT scan, prestroke modified Rankin Scale (mRS) score, Age, Glucose level at baseline, Onset-to-treatment time, and baseline National Institutes of Health Stroke Scale score (DRAGON) are typical imaging- and clinical-based scoring systems, respectively. Therefore, we compared predictability of stroke outcome of clinical (DRAGON)- and imaging (ASPECTS)-based scoring systems.
  
  
  METHODS
  We analyzed patients who were diagnosed with middle cerebral artery territory stroke and treated with i.v. alteplase at Gachon University Gil Hospital over 5 years and compared performance of 2 scoring systems for prediction of good functional outcome (mRS, 0-2) with Pearson correlation and area under the curve-receiver operating characteristic (AUC-ROC). In addition, we analyzed predicting power of several clinical factors and 2 scoring systems by multiple regression analysis.
  
  
  RESULTS
  Study population (N = 120) had mean age of 66.2 ± 13.2 years. ASPECTS (r = -.841, P < .0001) and DRAGON (r = .657, P < .0001) were significantly correlated with good functional outcome. In addition, statistical comparisons suggested that ASPECTS (AUC-ROC, .972; 95% confidence interval [CI], .947-.996) is significantly superior to DRAGON (AUC-ROC, .854; 95% CI, .786-.922) in predicting functional outcome (difference between areas, .118 ± .0332; 95% CI, .0559-.180, P = .0002). Multiple regression analysis revealed that ASPECTS was the independent predictor of good prognosis (OR, 6.59 per 1-point increase; 95% CI, 2.35-18.49; P < .0001 and OR, 77.67 for ASPECTS ≥ 8; 95% CI, 14.30-421.79; P < .0001).
  
  
  CONCLUSIONS
  ASPECTS is superior method for predicting functional outcome in acute ischemic stroke patients receiving i.v. alteplase compared with DRAGON and integration of ASPECTS score into clinical care pathway as decision-making tool can be reasonable.
authors.affiliation: Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Joon Hyun
authors.initials: JH
authors.lastname: Baek
authors.affiliation: Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Kitae
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Yeong-Bae
authors.initials: YB
authors.lastname: Lee
authors.affiliation: Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Kee-Hyung
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Hyeon-Mi
authors.initials: HM
authors.lastname: Park
authors.affiliation: Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Dong-Jin
authors.initials: DJ
authors.lastname: Shin
authors.affiliation: Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea.
authors.forename: Young Hee
authors.initials: YH
authors.lastname: Sung
authors.affiliation: Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea. Electronic address: dr.donghoon.shin@gmail.com.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Bang
mesh_terms: D000203:Activities of Daily Living; D061605:Administration, Intravenous; D000368:Aged; D019540:Area Under Curve; D002533:Cerebral Angiography / Q000379:methods*; D003661:Decision Support Techniques; D019033:Delivery of Health Care, Integrated; D004185:Disability Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006785:Hospitals, University; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D020127:Recovery of Function; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: ASPECTS score; Cerebral infarct; DRAGON score; outcomes; prognosis; thrombolysis