Poor performance of stroke prognostication using Age and National Institutes of Health Stroke Scale-100 to predict 3- and 12-month outcomes of ischemic stroke in China National Stroke Registry

J Stroke Cerebrovasc Dis. 2014 Oct;23(9):2335-40. doi: 10.1016/j.jstrokecerebrovasdis.2014.04.031. Epub 2014 Sep 4.

Abstract

Background: Stroke Prognostication using Age and NIH (National Institutes of Health) Stroke Scale (SPAN)-100 is a simple and easy-to-use tool for assessing the outcomes of ischemic stroke after thrombolysis. To explore its application, we evaluated SPAN-100's prognostic value in predicting 3- and 12-month outcomes in general ischemic stroke patients.

Methods: We applied the SPAN-100 to ischemic stroke patients from the China National Stroke Registry. Poor outcome was defined as a modified Rankin Scale of 2-6. Discrimination of SPAN-100 was assessed by the area under the receiver-operator curves (AUC) and 95% confidence intervals (CI). We also performed an exploratory post hoc analysis of the performance of the SPAN index score using 80 as the cutoff point.

Results: Among 11,894 ischemic stroke patients, 479 (4.0%) patients were SPAN-100 positive. The AUC of SPAN-100 for poor outcome was .54 (95% CI, .54-.54) at 3 months and .54 (95% CI, .54-.55) at 12 months, respectively. In the exploratory analysis, when 80 was used as the cutoff point of SPAN index score, the AUC for poor outcome was .66 (95% CI, .66-.67) at 3 months and .68 (95% CI, .67-.68) at 12 months, respectively.

Conclusions: SPAN-100 suffered from low prediction power for 3- and 12-month outcomes of ischemic stroke in Chinese population. A cutoff point of 80 may improve the performance, but none of them had an AUC above the threshold of .8 required for use in individuals.

Keywords: SPAN-100; ischemic stroke; outcome; prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging*
  • Alcoholism / complications
  • Asian People / statistics & numerical data*
  • Brain Ischemia / diagnosis
  • Brain Ischemia / epidemiology*
  • China / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Registries
  • Risk Factors
  • Smoking / adverse effects
  • Stroke / diagnosis
  • Stroke / epidemiology*
  • Treatment Outcome