title: TURN Score Predicts 90-day Outcome in Acute Ischemic Stroke Patients After IV Thrombolysis.
abstract: OBJECTIVE
  We developed the TURN score for predicting symptomatic intracerebral hemorrhage (sICH) after IV thrombolysis. Our purpose was to evaluate its ability to predict 90-day outcome.
  
  
  METHODS
  We retrospectively analyzed data from 303 patients who received IV rt-PA during the NINDS rt-PA trial. Severe outcome was defined as 90-day modified Rankin scale (mRS) scores ≥5, 90-day Barthel index (BI) scores <60 and 90-day Glasgow Outcome Scale (GOS) scores >2. Excellent outcome was defined as 90-day mRS scores ≤1, 90-day BI scores ≥95 and 90-day GOS scores = 1. Agreement between TURN and 90-day outcome was assessed by univariate logistic regression reporting odds ratios (OR) and by areas under the receiver operating characteristic curves (AUROC). TURN was also compared with 6 other scores for predicting sICH or severe outcome.
  
  
  RESULTS
  TURN predicted 90-day mRS ≥5 with OR 5.73, 95% confidence interval (3.60, 9.10), P < 0.001 and AUROC 0.83, 95% confidence interval (0.77, 0.89). TURN also predicted 90-day mRS ≤1 with OR 5.24, 95% confidence interval (3.43, 7.99), P < 0.001 and AUROC 0.80, 95% confidence interval (0.74, 0.85). TURN predicted 90-day mRS ≥5 with OR significantly higher than DRAGON (2.30, P = 0.01), ASTRAL (1.18, P < 0.001), HAT (2.89, P = 0.05) and SEDAN (2.16, P = 0.01), and with AUROC significantly higher than SPAN-100 (0.64, P < 0.001) and SEDAN (0.71, P = 0.01). Likewise, TURN predicted 90-day mRS ≤1 with OR significantly higher than Stroke-TPI (2.89, P = 0.05), DRAGON (2.29, P = 0.01), ASTRAL (1.15, P < 0.001), HAT (2.71, P = 0.04) and SEDAN (2.15, P = 0.01), and with AUROC significantly higher than SPAN-100 (0.58, P < 0.001) and SEDAN (0.70, P = 0.01). Similar results were obtained using 90-day BI and 90-day GOS scores.
  
  
  CONCLUSIONS
  TURN predicted 90-day outcome with comparable or better accuracy compared to several existing clinical scores.
authors.affiliation: Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA, david.asuzu@yale.edu.
authors.forename: David
authors.initials: D
authors.lastname: Asuzu
authors.forename: Karin
authors.initials: K
authors.lastname: Nyström
authors.forename: Joseph
authors.initials: J
authors.lastname: Schindler
authors.forename: Charles
authors.initials: C
authors.lastname: Wira
authors.forename: David
authors.initials: D
authors.lastname: Greer
authors.forename: Janet
authors.initials: J
authors.lastname: Halliday
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Sheth
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D005500:Follow-Up Studies; D006801:Humans; D015337:Multicenter Studies as Topic; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D010959:Tissue Plasminogen Activator