title: Risk rtPA: An iOS mobile application based on TURN for predicting 90-day outcome after IV thrombolysis.
abstract: OBJECTIVE
  We recently developed Thrombolysis risk Using mRS and NIHSS (TURN), a simple score using only prestroke mRS scores and admission NIHSS scores to predict 90-day outcome after IV thrombolysis in ischemic stroke patients. Our purpose was to develop and test a mobile application for utilization of TURN at the bedside.
  
  
  METHODS
  We developed Risk rtPA, an iOS mobile application based on TURN for prediction of 90-day excellent and severe outcome after IV thrombolysis. Excellent outcome was defined as 90-day mRS≤1. Severe outcome was defined as 90-day mRS≥5. Predictors for excellent and severe outcome were calculated using the inverse logit of -TURN and TURN respectively. We retrospectively validated our mobile application using data from 303 patients who received IV rt-PA during the NINDS rt-PA trial. Sensitivity and specificity analyses were performed using receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  Prediction of excellent and severe outcome using Risk rtPA followed an S-shaped curve as expected. We confirmed this finding using data from the NINDS trial. Cutoffs selected after ROC analysis predicted severe outcome with sensitivity of 94.4% and specificity of 52.2%, and excellent outcome with specificity of 83.9% and sensitivity of 61.2%.
  
  
  CONCLUSIONS
  The Risk rtPA mobile application predicted 90-day excellent and severe outcome in most clinically relevant cases. This mobile application brings the TURN score to the bedside for prediction of 90-day outcome in ischemic stroke patients being evaluated for IV thrombolysis.
authors.affiliation: Yale School of Medicine, New Haven, CT, United States.
authors.forename: David
authors.initials: D
authors.lastname: Asuzu
authors.affiliation: Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, United States.
authors.forename: Karin
authors.initials: K
authors.lastname: Nystrӧm
authors.affiliation: Yale School of Medicine, New Haven, CT, United States; Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schindler
authors.affiliation: Yale School of Medicine, New Haven, CT, United States; Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, United States.
authors.forename: Charles
authors.initials: C
authors.lastname: Wira
authors.affiliation: Yale School of Medicine, New Haven, CT, United States; Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, United States.
authors.forename: David
authors.initials: D
authors.lastname: Greer
authors.affiliation: Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, United States.
authors.forename: Janet
authors.initials: J
authors.lastname: Halliday
authors.affiliation: Yale School of Medicine, New Haven, CT, United States; Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, United States. Electronic address: kevin.sheth@yale.edu.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Sheth
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D063731:Mobile Applications; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000175:diagnosis*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: IV Thrombolysis; Intracerebral hemorrhage; Predictive scores; Recombinant tissue plasminogen activator; Severe outcomes