The immediate outcome for a patient after a cerebrovascular accident can be predicted using a prognostic score based on early clinical findings. This was developed by Drs Rodrigues and Joshi at BYL Nair Hospital in Bombay, India.
Patient population: 120 consecutive patients from August 1986 to January 1987 .
Parameters for clinical score:
(1) age
(2) history of previous stroke
(3) level of consciousness (mental obtundation)
(4) persistent altered consciousness
(5) altered consciousness appearing in first 24 to 72 hours
(6) presence of complete hemiplegia
(7) seizures during hospital stay
(8) aspiration pneumonitis
Features for CT score:
(1) massive and/or multiple lesions
(2) gross mass effect
|
Level of Consciousness |
Grade of Mental Obtundation |
|
patient alert and well-oriented |
Grade 0 |
|
drowsy but arousable |
Grade 1 |
|
responding to deep, painful stimuli only |
Grade 2 |
|
deeply comatose, not responding to deep painful stimuli |
Grade 3 |
|
Clinical Parameters |
Finding |
Points |
|
age |
age in years |
0.4 * (age) |
|
history of previous stroke |
yes |
+18 |
|
|
no |
0 |
|
mental obtundation at onset |
grade 0 |
0 |
|
|
grade 1 |
+8 |
|
|
grades 2 or 3 |
see below |
|
persistent altered consciousness (beyond the first 48 hours) |
yes |
+40 |
|
|
no |
0 |
|
altered consciousness appearing in first 24-72 hours |
yes |
+23 |
|
|
no |
0 |
|
complete hemiplegia |
yes |
+6 |
|
|
no |
0 |
|
seizures during hospital stay |
yes |
+15 |
|
|
no |
0 |
|
aspiration pneumonitis |
yes |
+32 |
|
|
no |
0 |
|
constant |
|
-21 |
where:
• The points assigned are based on the coefficients from multiple regression analysis (= 100 times the unstandardized coefficient).
|
CT Features |
Finding |
Points |
|
massive and/or multiple lesions |
yes |
+30 |
|
|
no |
0 |
|
gross mass effect |
yes |
+22 |
|
|
no |
0 |
|
constant |
|
+3 |
where:
• intraventricular extension in lobar hematomas was another feature seen on CT scans, but was only present in a small number of patients.
prognostic score based on clinical variables =
= SUM(points for all 8 parameters) + (constant)
prognostic score based on CT features =
= (points for massive or multiple lesions) + (points for gross mass effect) + (constant)
Interpretation:
• If the mental obtundation was Grade 2 or 3, then all patients died.
• The minimum CT score is 3, and the maximum is 55.
• The CT score used a breakpoint of >= 34 and <= 33 to identify bad and good outcomes, but it was less accurate than that using the score based on clinical parameters.
• The clinical scores are affected by the age of the patient. The maximum clinical score may be > 150 and the minimum may be < -9.
• Patients with clinical scores <= 46 had a 50% or better chance of survival, while patients with scores >= 47 had a 50% or greater chance of death.
• A clinical score <= 12 was associated with 99% chance of survival.
• A clinical score >= 63 was associated with 99% chance of death.
Limitation:
• This score was developed over 10 years ago, and better technologies have resulted in better survivals.
• The score does not indicate the quality of life or incapacity in the survivors.
Specialty: Neurology
ICD-10: ,
