Thinking about the future: a review of prognostic scales used in acute stroke

Drozdowska, B. A. , Singh, S. and Quinn, T. J. (2019) Thinking about the future: a review of prognostic scales used in acute stroke. Frontiers in Neurology, 10, 274. (doi: 10.3389/fneur.2019.00274) (PMID:30949127) (PMCID:PMC6437031)

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Abstract

Background: There are many prognostic scales that aim to predict functional outcome following acute stroke. Despite considerable research interest, these scales have had limited impact in routine clinical practice. This may be due to perceived problems with internal validity (quality of research), as well as external validity (generalizability of results). We set out to collate information on exemplar stroke prognosis scales, giving particular attention to the scale content, derivation, and validation. Methods: We performed a focused literature search, designed to return high profile scales that use baseline clinical data to predict mortality or disability. We described prognostic utility and collated information on the content, development and validation of the tools. We critically appraised chosen scales based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modeling Studies (CHARMS). Results: We chose 10 primary scales that met our inclusion criteria, six of which had revised/modified versions. Most primary scales used 5 input variables (range: 4–13), with substantial overlap in the variables included. All scales included age, eight included a measure of stroke severity, while five scales incorporated pre-stroke level of function (often using modified Rankin Scale), comorbidities and classification of stroke type. Through our critical appraisal, we found issues relating to excluding patients with missing data from derivation studies, and basing the selection of model variable on significance in univariable analysis (in both cases noted for six studies). We identified separate external validation studies for all primary scales but one, with a total of 60 validation studies. Conclusions: Most acute stroke prognosis scales use similar variables to predict long-term outcomes and most have reasonable prognostic accuracy. While not all published scales followed best practice in development, most have been subsequently validated. Lack of clinical uptake may relate more to practical application of scales rather than validity. Impact studies are now necessary to investigate clinical usefulness of existing scales.

Item Type:Articles
Keywords:Functional outcome, prognostic scale, risk score, stroke, validation.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Quinn, Professor Terry and Drozdowska, Bogna and Singh, Dr Sarjit
Authors: Drozdowska, B. A., Singh, S., and Quinn, T. J.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Frontiers in Neurology
Publisher:Frontiers Media
ISSN:1664-2295
ISSN (Online):1664-2295
Copyright Holders:Copyright © 2019 Drozdowska, Singh and Quinn
First Published:First published in Frontiers in Neurology 10: 274
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
172806Improving assessment, prediction and understanding of the short, medium and longer term neuropsychological consequences of strokeTerence QuinnStroke Association (STROKEAS)PPA2015/01_CSOInstitute of Cardiovascular & Medical Sciences
171459Joint Stroke Association/Chief Scientist Office Senior Clinical Lectureship - STOKE ASSOCIATION REF TSA LECT 2015/05Terence QuinnStroke Association (STROKEAS)TSA LECT 2015/05Institute of Cardiovascular & Medical Sciences