Simple prediction scores predict good and devastating outcomes after stroke more accurately than physicians.
physicians are often asked to prognosticate soon after a patient presents with stroke. This study aimed to compare two outcome prediction scores (Five Simple Variables [FSV] score and the PLAN [Preadmission comorbidities, Level of consciousness, Age, and focal Neurologic deficit]) with informal prediction by physicians.



demographic and clinical variables were prospectively collected from consecutive patients hospitalised with acute ischaemic or haemorrhagic stroke (2012-13). In-person or telephone follow-up at 6 months established vital and functional status (modified Rankin score [mRS]). Area under the receiver operating curves (AUC) was used to establish prediction score performance.



five hundred and seventy-five patients were included; 46% female, median age 76 years, 88% ischaemic stroke. Six months after stroke, 47% of patients had a good outcome (alive and independent, mRS 0-2) and 26% a devastating outcome (dead or severely dependent, mRS 5-6). The FSV and PLAN scores were superior to physician prediction (AUCs of 0.823-0.863 versus 0.773-0.805, P < 0.0001) for good and devastating outcomes. The FSV score was superior to the PLAN score for predicting good outcomes and vice versa for devastating outcomes (P < 0.001). Outcome prediction was more accurate for those with later presentations (>24 hours from onset).



the FSV and PLAN scores are validated in this population for outcome prediction after both ischaemic and haemorrhagic stroke. The FSV score is the least complex of all developed scores and can assist outcome prediction by physicians.
Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK.
John Michael
JM
Reid
Department of Informatics, Independence Blue Cross, Philadelphia, PA, USA.
Dingwei
D
Dai
Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK.
Susanna
S
Delmonte
Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Carl
C
Counsell
Dalhousie University Department of Medicine, and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
Stephen J
SJ
Phillips
Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK.
Mary Joan
MJ
MacLeod
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002545:Brain Ischemia / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D015897:Comorbidity; D003243:Consciousness; D003661:Decision Support Techniques; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012606:Scotland; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D000071939:Stroke Rehabilitation; D013997:Time Factors
older people; outcome prediction; prognosis; stroke