_id

683a1619c782e11e38d1b1c0

id

3967

title

ASTRAL Score for Ischemic Stroke

full_title

ASTRAL Score for Ischemic Stroke

short_title

ASTRAL Score

med_description

Predicts 90-day poor outcome in patients with acute ischemic stroke.

short_description

90-day poor outcome in stroke.

slug

astral-score-stroke

description

ASTRAL Score for Ischemic Stroke predicts 90-day poor outcome in patients with acute ischemic stroke.

keywords

Astral, stroke, cva, tia, ischemic stroke, athens stroke registry, outcome, mortality, stroke score, dragon score, sedan score, soar score, modified soar score, msoar score, iscore, plan score, isss, ischemic stroke survival score

complaint

[ "AMS", "Neurologic Deficit", "Weakness" ]

formula

Addition of the selected points:

evidence

The ASTRAL (Acute Stroke Registry and Analysis of Lausanne) Score was originally developed in a study by Ntaios et al in 2012, which identified six clinical and laboratory predictors of poor functional outcome, defined as a Modified Rankin Scale result of 3–6 at 90 days in a registry of patients with acute ischemic stroke from Lausanne, Switzerland (n = 1,645).

The AUC was 0.85 in the derivation cohort; this study also had an internal validation of the score using separate stroke registry cohorts from Athens (n = 1,659; AUC 0.94) and Vienna (n = 653; AUC 0.77). The Hosmer-Lemeshow goodness-of-fit test was non-significant in all cohorts, indicating a well-calibrated score (derivation, p = 0.43; Athens, p = 0.22; Vienna, p = 0.49).

The ASTRAL Score was determined to have the following specificities, sensitivities, and positive and negative predictive values for determining functional outcome (mRS 3–6) at 90 days at the cut-points below. Note: Due to low numbers of observations, numbers associated with the highest ASTRAL Scores should be interpreted with caution.

The ASTRAL Score was subsequently validated by Liu et al (2013) in a Chinese cohort (n = 3,755). The AUC was comparable to that determined in the original derivation study by Ntaios et al (AUC 0.82, 95%CI, 0.81-0.83).

In the largest validation study of the ASTRAL Score to date, Cooray et al (2016) examined the prediction of functional outcomes in patients with acute ischemic stroke treated with IV thrombolysis as part of the SITS-ISTR (Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register; n = 36,131). While the AUC of the ASTRAL score was 0.79 (95%CI, 0.786 – 0.795), the SITS-ISTR cohort had a higher mean NIH stroke scale (12.2 vs. 8.9, p<0.0001), a shorter time from onset to assessment (82.2 min vs. 395.8 min, p<0.0001) and a smaller proportion of patients achieving 0-2 at 90 days (57.4% vs 66%) than the original derivation cohort.

Multiple external validations have been conducted for the ASTRAL Score’s ability to predict post-stroke outcomes not examined in the original ASTRAL Score derivation study, including:

• 12-month functional outcome (Liu 2013).
• 5-year functional outcome (Papavasileou 2013).
• Mortality at 5 years (Papavasileou 2013).
• In-hospital functional outcome and mortality (Kuster 2016).

In addition, a recent analysis of a large independent European dataset showed that the ASTRAL Score performed best when compared to 6 similar prognostic scores, though the authors cautioned that it still may not prognosticate well enough to be used as the only basis for clinical decision making (Quinn 2017).

measurements

[ { "name": "Age", "unit": "age", "error_min": "0.001", "error_max": "120", "warn_min": "0.1", "warn_max": "100", "conversion": "1", "normal_max_si": "0", "normal_max_us": "0", "normal_min_si": "0", "normal_min_us": "0", "units_si": "years", "units_us": "years" }, { "name": "NIH Stroke Scale", "unit": "nihss", "error_min": "0", "error_max": "42", "warn_min": "0", "warn_max": "42", "conversion": "1", "normal_max_si": "42", "normal_max_us": "42", "normal_min_si": "0", "normal_min_us": "0", "units_si": "points", "units_us": "points" } ]

information

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/22649218", "text": "Ntaios G, Faouzi M, Ferrari J, Lang W, Vemmos K, Michel P. An integer-based score to predict functional outcome in acute ischemic stroke: the ASTRAL score. Neurology. 2012;78(24):1916-22." } ], "Other References": [], "Outcomes": [], "Validation": [ { "href": "https://stroke.ahajournals.org/content/47/6/1493", "text": "Cooray C, Mazya M, Bottai M, Dorado L, Skoda O, Toni D, Ford GA, Wahlgren N, Ahmed N. External Validation of the ASTRAL and DRAGON Scores for Prediction of Functional Outcome in Stroke. Stroke. 2016;47:1493-1499." }, { "href": "https://stroke.ahajournals.org/content/44/5/1443 ", "text": "Liu G, Ntaios G, Zheng H, et al. External validation of the ASTRAL score to predict 3- and 12-month functional outcome in the China National Stroke Registry. Stroke. 2013;44(5):1443-5." }, { "href": "https://stroke.ahajournals.org/content/44/6/1616", "text": "Papavasileiou V, Milionis H, Michel P, et al. ASTRAL score predicts 5-year dependence and mortality in acute ischemic stroke. Stroke. 2013;44(6):1616-20." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/26982991", "text": "Kuster GW, Dutra LA, Brasil IP, Pacheco EP, Arruda MJ, Volcov C, Domingues RB. Performance of four ischemic stroke prognostic scores in a Brazilian population. Arq Neuropsiquiatr. 2016;74(2):133-7." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/28794250", "text": "Quinn TJ, Singh S, Lees KR, Bath PM, Myint PK. Validating and comparing stroke prognosis scales. Neurology. 2017;89(10):997-1002." } ], "Validations": [] }

pearls

• The ASTRAL Score uses clinical characteristics and laboratory testing to predict the likelihood that a given patient with acute ischemic stroke will have a Modified Rankin Scale result of 3–6 at 90 days after stroke.
• Developed to predict a dichotomous outcome, not a discrete Modified Rankin Scale score at 90 days.

• Does not predict mortality or degree of improvement from any form of rehabilitation.
• Should not be used as a surrogate for stroke severity.

usecase

Patients with acute ischemic stroke admitted within 24 hours of stroke onset.

reasons

Can provide additional information on medium-term functional outcome in patients that have suffered acute ischemic stroke, in addition to clinical judgment based on relevant clinical and laboratory variables. Does not need neuroimaging data to calculate. Can be used to adjust for functional outcome in multivariate models in acute stroke-related research studies. Can serve as a selection criterion for cohorts in acute stroke-related research studies.

next_advice

• Acute ischemic stroke is a neurological emergency that is amenable to time-sensitive treatments (e.g. tPA, mechanical thrombectomy) if certain clinical conditions are met.
• Neurological consultation should be obtained immediately in suspected cases of acute ischemic stroke.
• Should not be used as a substitute for clinical judgment and is intended for use as an adjunct to medical decision-making.

next_actions

• Intravenous tissue plasminogen activator (IV tPA) is the standard-of-care treatment for adult patients presenting with acute ischemic stroke within 4.5 hours of symptom onset, if no exclusion criteria are met.
• Mechanical thrombectomy is the standard-of-care treatment for selected adult patients presenting with acute ischemic stroke due to LVO presenting in the acute setting.
• Note that the appropriateness of patient for endovascular intervention depends on multiple factors, such as time since onset, neuroimaging, baseline functional status, and others.
• Appropriateness for intravenous thrombolysis or mechanical thrombectomy should be determined by neurological/neurosurgical consultant whenever available.

next_management

• In cases of suspected ischemic stroke, the following is recommended:
• STAT neurological consultation.
• STAT CT head without contrast.
• STAT laboratory testing (complete blood count, PT/INR/aPTT, basic metabolic panel, type & screen, troponin-I).
• Consider STAT CT angiogram of the head & neck in cases of suspected large-vessel occlusion (LVO) presenting in the acute setting.

diseases

[ "Stroke/TIA" ]

input_schema

[ { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Age</p>", "name": "age", "optional": false, "tips_en": "", "type": "textbox", "unit": "age" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p><abbr title=\"NIH Stroke Scale\">NIHSS</abbr><calculator id=\"715\"> Score</calculator></p>", "name": "severe", "optional": false, "tips_en": "", "type": "textbox", "unit": "nihss" }, { "conditionality": "", "default": 0, "label_en": "<p>&gt;3 hrs from symptom onset (or last time seen WITHOUT stroke symptoms) to admission</p>", "md_calc_info_concept": null, "name": "time", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "<p>Any new visual field defect</p>", "md_calc_info_concept": null, "name": "defect", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "<p>Admission glucose &gt;131 mg/dL (7.3 mmol/L) or &lt;66 mg/dL (3.7 mmol/L)</p>", "md_calc_info_concept": null, "name": "glucose", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "<p>Impaired consciousness</p>", "md_calc_info_concept": null, "name": "loc", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 3 } ], "show_points": true, "tips_en": "", "type": "toggle" } ]

instructions

Use in patients with acute ischemic stroke admitted within 24 hours of stroke onset.

published

2022-04-21T20:29:30.755Z

purpose

[ "Prognosis" ]

search_terms

[ "astral", "athens", "stroke score", "cva", "tia", "ischemic stroke", "brain attack" ]

seo

{ "keywords_en": "Astral, stroke, cva, tia, ischemic stroke, athens stroke registry, outcome, mortality, stroke score, dragon score, sedan score, soar score, modified soar score, msoar score, iscore, plan score, isss, ischemic stroke survival score", "meta_description_en": "ASTRAL Score for Ischemic Stroke predicts 90-day poor outcome in patients with acute ischemic stroke." }

specialty

[ "Cardiology", "Critical Care (Neurologic)", "Neurology" ]

departments

[ "Cardiac", "Neurologic" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 3965, "short_title_en": "PLAN Score for Stroke", "slug": "plan-score-stroke" }, { "calcId": 3966, "short_title_en": "mSOAR Score", "slug": "modified-soar-score-stroke" }, { "calcId": 3959, "short_title_en": "LAMS", "slug": "los-angeles-motor-scale-lams" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "cardiology", "neurology" ]

cleaned_use

[ "Patients with acute ischemic stroke admitted within 24 hours of stroke onset." ]

pub

false