Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt

Amelia K. Boehme, Pawan Rawal, Michael J. Lyerly, Karen C. Albright, Reza Bavarsad Shahripour, Paola Palazzo, Niren Kapoor, Mohammad Alvi, J. Thomas Houston, Mark R. Harrigan, Luis Cava, April Sisson, Anne Alexandrov, Andrei Alexandrov

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Abstract

Background To assess the utility of previously developed scoring systems, we compared SEDAN, named after the components of the score (baseline blood Sugar, Early infarct signs and (hyper) Dense cerebral artery sign on admission computed tomography scan, Age, and National Institutes of Health Stroke Scale on admission), Totaled Health Risks in Vascular Events (THRIVE), Houston Intra-arterial Therapy (HIAT), and HIAT-2 scoring systems among patients receiving systemic (intravenous [IV] tissue plasminogen activator [tPA]) and endovascular (intra-arterial [IA]) treatments.

Methods We retrospectively reviewed all IV tPA and IA patients presenting to our center from 2008-2011. The scores were assessed in patients who were treated with IV tPA only, IA only, and a combination of IV tPA and IA (IV-IA). We tested the ability of THRIVE to predict discharge modified Rankin scale (mRS) 3-6, HIAT and HIAT-2 discharge mRS 4-6, and SEDAN symptomatic intracerebral hemorrhage (sICH).

Results Of the 366 patients who were included in this study, 243 had IV tPA only, 89 had IA only, and 34 had IV-IA. THRIVE was predictive of mRS 3-6 in the IV-IA (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.30-2.91) and the IV group (OR, 1.71; 95% CI, 1.43-2.04), but not in the IA group. HIAT was predictive of mRS 4-6 in the IA (OR, 3.55; 95% CI, 1.65-7.25), IV (OR, 3.47; 95% CI, 2.26-5.33), and IV-IA group (OR, 6.48; 95% CI, 1.41-29.71). HIAT-2 was predictive of mRS 4-6 in the IA (OR, 1.39; 95% CI, 1.03-1.87) and IV group (OR, 1.36; 95% CI, 1.18-1.57), but not in the IV-IA group. SEDAN was not predictive of sICH in the IA or the IV-IA group, but was predictive in the IV group (OR, 1.54; 95% CI, 1.01-2.36).

Conclusions Our study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.

Original languageEnglish (US)
Pages (from-to)2001-2006
Number of pages6
JournalJournal of Stroke and Cerebrovascular Diseases
Volume23
Issue number8
DOIs
StatePublished - Sep 1 2014

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Stroke
Odds Ratio
Confidence Intervals
Tissue Plasminogen Activator
Blood Vessels
Cerebral Hemorrhage
Therapeutics
Health
Cerebral Arteries
National Institutes of Health (U.S.)
Blood Glucose
Tomography

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt. / Boehme, Amelia K.; Rawal, Pawan; Lyerly, Michael J.; Albright, Karen C.; Bavarsad Shahripour, Reza; Palazzo, Paola; Kapoor, Niren; Alvi, Mohammad; Houston, J. Thomas; Harrigan, Mark R.; Cava, Luis; Sisson, April; Alexandrov, Anne; Alexandrov, Andrei.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 23, No. 8, 01.09.2014, p. 2001-2006.

Research output: Contribution to journalArticle

Boehme, AK, Rawal, P, Lyerly, MJ, Albright, KC, Bavarsad Shahripour, R, Palazzo, P, Kapoor, N, Alvi, M, Houston, JT, Harrigan, MR, Cava, L, Sisson, A, Alexandrov, A & Alexandrov, A 2014, 'Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt', Journal of Stroke and Cerebrovascular Diseases, vol. 23, no. 8, pp. 2001-2006. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.02.003
Boehme, Amelia K. ; Rawal, Pawan ; Lyerly, Michael J. ; Albright, Karen C. ; Bavarsad Shahripour, Reza ; Palazzo, Paola ; Kapoor, Niren ; Alvi, Mohammad ; Houston, J. Thomas ; Harrigan, Mark R. ; Cava, Luis ; Sisson, April ; Alexandrov, Anne ; Alexandrov, Andrei. / Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt. In: Journal of Stroke and Cerebrovascular Diseases. 2014 ; Vol. 23, No. 8. pp. 2001-2006.
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title = "Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt",
abstract = "Background To assess the utility of previously developed scoring systems, we compared SEDAN, named after the components of the score (baseline blood Sugar, Early infarct signs and (hyper) Dense cerebral artery sign on admission computed tomography scan, Age, and National Institutes of Health Stroke Scale on admission), Totaled Health Risks in Vascular Events (THRIVE), Houston Intra-arterial Therapy (HIAT), and HIAT-2 scoring systems among patients receiving systemic (intravenous [IV] tissue plasminogen activator [tPA]) and endovascular (intra-arterial [IA]) treatments.Methods We retrospectively reviewed all IV tPA and IA patients presenting to our center from 2008-2011. The scores were assessed in patients who were treated with IV tPA only, IA only, and a combination of IV tPA and IA (IV-IA). We tested the ability of THRIVE to predict discharge modified Rankin scale (mRS) 3-6, HIAT and HIAT-2 discharge mRS 4-6, and SEDAN symptomatic intracerebral hemorrhage (sICH).Results Of the 366 patients who were included in this study, 243 had IV tPA only, 89 had IA only, and 34 had IV-IA. THRIVE was predictive of mRS 3-6 in the IV-IA (odds ratio [OR], 1.95; 95{\%} confidence interval [CI], 1.30-2.91) and the IV group (OR, 1.71; 95{\%} CI, 1.43-2.04), but not in the IA group. HIAT was predictive of mRS 4-6 in the IA (OR, 3.55; 95{\%} CI, 1.65-7.25), IV (OR, 3.47; 95{\%} CI, 2.26-5.33), and IV-IA group (OR, 6.48; 95{\%} CI, 1.41-29.71). HIAT-2 was predictive of mRS 4-6 in the IA (OR, 1.39; 95{\%} CI, 1.03-1.87) and IV group (OR, 1.36; 95{\%} CI, 1.18-1.57), but not in the IV-IA group. SEDAN was not predictive of sICH in the IA or the IV-IA group, but was predictive in the IV group (OR, 1.54; 95{\%} CI, 1.01-2.36).Conclusions Our study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.",
author = "Boehme, {Amelia K.} and Pawan Rawal and Lyerly, {Michael J.} and Albright, {Karen C.} and {Bavarsad Shahripour}, Reza and Paola Palazzo and Niren Kapoor and Mohammad Alvi and Houston, {J. Thomas} and Harrigan, {Mark R.} and Luis Cava and April Sisson and Anne Alexandrov and Andrei Alexandrov",
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TY - JOUR

T1 - Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt

AU - Boehme, Amelia K.

AU - Rawal, Pawan

AU - Lyerly, Michael J.

AU - Albright, Karen C.

AU - Bavarsad Shahripour, Reza

AU - Palazzo, Paola

AU - Kapoor, Niren

AU - Alvi, Mohammad

AU - Houston, J. Thomas

AU - Harrigan, Mark R.

AU - Cava, Luis

AU - Sisson, April

AU - Alexandrov, Anne

AU - Alexandrov, Andrei

PY - 2014/9/1

Y1 - 2014/9/1

N2 - Background To assess the utility of previously developed scoring systems, we compared SEDAN, named after the components of the score (baseline blood Sugar, Early infarct signs and (hyper) Dense cerebral artery sign on admission computed tomography scan, Age, and National Institutes of Health Stroke Scale on admission), Totaled Health Risks in Vascular Events (THRIVE), Houston Intra-arterial Therapy (HIAT), and HIAT-2 scoring systems among patients receiving systemic (intravenous [IV] tissue plasminogen activator [tPA]) and endovascular (intra-arterial [IA]) treatments.Methods We retrospectively reviewed all IV tPA and IA patients presenting to our center from 2008-2011. The scores were assessed in patients who were treated with IV tPA only, IA only, and a combination of IV tPA and IA (IV-IA). We tested the ability of THRIVE to predict discharge modified Rankin scale (mRS) 3-6, HIAT and HIAT-2 discharge mRS 4-6, and SEDAN symptomatic intracerebral hemorrhage (sICH).Results Of the 366 patients who were included in this study, 243 had IV tPA only, 89 had IA only, and 34 had IV-IA. THRIVE was predictive of mRS 3-6 in the IV-IA (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.30-2.91) and the IV group (OR, 1.71; 95% CI, 1.43-2.04), but not in the IA group. HIAT was predictive of mRS 4-6 in the IA (OR, 3.55; 95% CI, 1.65-7.25), IV (OR, 3.47; 95% CI, 2.26-5.33), and IV-IA group (OR, 6.48; 95% CI, 1.41-29.71). HIAT-2 was predictive of mRS 4-6 in the IA (OR, 1.39; 95% CI, 1.03-1.87) and IV group (OR, 1.36; 95% CI, 1.18-1.57), but not in the IV-IA group. SEDAN was not predictive of sICH in the IA or the IV-IA group, but was predictive in the IV group (OR, 1.54; 95% CI, 1.01-2.36).Conclusions Our study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.

AB - Background To assess the utility of previously developed scoring systems, we compared SEDAN, named after the components of the score (baseline blood Sugar, Early infarct signs and (hyper) Dense cerebral artery sign on admission computed tomography scan, Age, and National Institutes of Health Stroke Scale on admission), Totaled Health Risks in Vascular Events (THRIVE), Houston Intra-arterial Therapy (HIAT), and HIAT-2 scoring systems among patients receiving systemic (intravenous [IV] tissue plasminogen activator [tPA]) and endovascular (intra-arterial [IA]) treatments.Methods We retrospectively reviewed all IV tPA and IA patients presenting to our center from 2008-2011. The scores were assessed in patients who were treated with IV tPA only, IA only, and a combination of IV tPA and IA (IV-IA). We tested the ability of THRIVE to predict discharge modified Rankin scale (mRS) 3-6, HIAT and HIAT-2 discharge mRS 4-6, and SEDAN symptomatic intracerebral hemorrhage (sICH).Results Of the 366 patients who were included in this study, 243 had IV tPA only, 89 had IA only, and 34 had IV-IA. THRIVE was predictive of mRS 3-6 in the IV-IA (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.30-2.91) and the IV group (OR, 1.71; 95% CI, 1.43-2.04), but not in the IA group. HIAT was predictive of mRS 4-6 in the IA (OR, 3.55; 95% CI, 1.65-7.25), IV (OR, 3.47; 95% CI, 2.26-5.33), and IV-IA group (OR, 6.48; 95% CI, 1.41-29.71). HIAT-2 was predictive of mRS 4-6 in the IA (OR, 1.39; 95% CI, 1.03-1.87) and IV group (OR, 1.36; 95% CI, 1.18-1.57), but not in the IV-IA group. SEDAN was not predictive of sICH in the IA or the IV-IA group, but was predictive in the IV group (OR, 1.54; 95% CI, 1.01-2.36).Conclusions Our study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.

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