Sung Sheng-Feng, Chen Yu-Wei, Hung Ling-Chien, Lin Huey-Juan
Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; Min-Hwei College of Health Care Management, Tainan, Taiwan.
Department of Neurology, Landseed Hospital, Tao-Yuan County, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1634-9. doi: 10.1016/j.jstrokecerebrovasdis.2014.01.010. Epub 2014 Apr 5.
The iScore is a validated tool to predict mortality and functional outcome after acute ischemic stroke. It incorporates stroke subtype according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification as one of its factors. However, the TOAST stroke subtype may not be easily determined without extensive investigations. We aimed to test if the stroke subtype can be substituted by the Oxfordshire Community Stroke Project (OCSP) classification. We applied the iScore and the revised iScore, in which the TOAST subtype was replaced by the OCSP classification, to patients admitted to a single hospital for acute ischemic stroke. Outcome measures included poor functional status (modified Rankin scale score, 3-6) at discharge and 3 months. The performance between the iScore and the revised iScore was assessed by determining the discrimination and calibration of the scores. We studied 3196 patients at the acute stage, and among them 2349 patients were available for the 3-month assessment. The discrimination of the revised iScore was comparable with the iScore for poor outcome at discharge (area under the receiver operating characteristic curve, .767 versus .775; P=.06) and at 3-month (.801 versus .810; P=.06). The correlation between the observed and the expected outcomes was high for both the iScore (Pearson correlation coefficient, .993 at discharge and .995 at 3 months; both P<.0001) and the revised iScore (.985 and .993, respectively; both P<.0001). The revised iScore reliably predicts clinical outcomes at discharge and 3 months for patients with acute ischemic stroke.
iScore是一种经过验证的工具，用于预测急性缺血性中风后的死亡率和功能转归。它将急性中风治疗中Org 10172试验（TOAST）分类的中风亚型作为其因素之一。然而，若无广泛的检查，TOAST中风亚型可能不易确定。我们旨在测试中风亚型是否可用牛津郡社区中风项目（OCSP）分类来替代。我们将iScore和修订后的iScore（其中TOAST亚型被OCSP分类所取代）应用于因急性缺血性中风入住单一医院的患者。结局指标包括出院时及3个月时功能状态不佳（改良Rankin量表评分，3 - 6分）。通过确定评分的区分度和校准度来评估iScore与修订后的iScore之间的性能。我们研究了3196例急性期患者，其中2349例患者可进行3个月的评估。修订后的iScore在出院时（受试者工作特征曲线下面积，.767对.775；P = 0.06）和3个月时（.801对.810；P = 0.06）对不良结局的区分度与iScore相当。iScore（Pearson相关系数，出院时为.993，3个月时为.995；均P < 0.0001）和修订后的iScore（分别为.985和.993；均P < 0.0001）观察到的与预期结局之间的相关性都很高。修订后的iScore能够可靠地预测急性缺血性中风患者出院时及3个月时的临床结局。
