Brain and Spine Institute, Southern Illinois Healthcare, Carbondale, Illinois, USA.
Southern Illinois University School of Medicine, Carbondale, Illinois, USA.
Cerebrovasc Dis Extra. 2024;14(1):148-157. doi: 10.1159/000541801. Epub 2024 Oct 4.
Early prediction of functional outcome after rtPA helps clinicians in prognostic conversations with stroke patients and their families. Three prognostic tools have been developed in this regard: DRAGON, MRI-DRAGON, and S-TPI scales. These tools, all performing with comparable accuracy, have been internally and externally validated in tertiary care centers. However, their performance in rural areas remains uncertain. This study addresses this gap in the literature by evaluating the effectiveness of those prognostic tools in stroke patients treated in a rural area of the Midwest.
We conducted a retrospective study of stroke patients treated with thrombolytics at Southern Illinois Healthcare Stroke Network from July 2017 to June 2024. Data on demographics, clinical presentations, laboratory values, neuroimaging, and stroke metrics were collected. Modified Rankin Scale (mRS) at 1 month, classified into good (mRS ≤2) and poor (mRS ≥5) outcomes were noted. DRAGON and MRI-DRAGON scores were calculated. S-TPI model was built. Area under the receiver operating characteristic curve (AUC) with its 95% confidence interval was calculated for each prognostic model.
A total of 279 patients were included in this study. Of those, 43% (n = 119) were male. Median age (interquartile range [IQR]) was 69 (57-80) years. NIHSS at presentation (IQR) was 7 (4-13). 12% of the cohort (n = 34) had posterior circulation stroke. At 1 month, 66% of patients (n = 185) had mRS ≤2, whereas 14% of patients (n = 39) had mRS ≥5. MRI-DRAGON showed the highest accuracy in predicting both good (AUC = 0.86, 95% CI: 0.81-0.90) and poor outcomes (AUC = 0.84, 95% CI: 0.76-0.91). DRAGON also demonstrated high accuracy for good (AUC = 0.85, 95% CI: 0.80-0.89) and poor (AUC = 0.82, 95% CI: 0.75-0.90) outcomes. Conversely, in our population, the S-TPI model had the lowest accuracy for good (AUC = 0.56, 95% CI: 0.49-0.63) and poor (AUC = 0.68, 95% CI: 0.61-0.76) outcomes.
Among the available grading scores, MRI-DRAGON score can be considered the more accurate short-term prognostic tool for stroke patients treated with rtPA in the rural setting.
rtPA 后功能预后的早期预测有助于临床医生与卒中患者及其家属进行预后对话。在这方面已经开发了三种预后工具：DRAGON、MRI-DRAGON 和 S-TPI 量表。这些工具在内部和外部的三级护理中心都进行了验证，准确性相当。然而，它们在农村地区的性能仍不确定。本研究通过评估这些预后工具在中西部农村地区治疗的卒中患者中的有效性来填补这一文献空白。
我们对 2017 年 7 月至 2024 年 6 月在南伊利诺伊州医疗保健卒中网络接受溶栓治疗的卒中患者进行了回顾性研究。收集了人口统计学、临床表现、实验室值、神经影像学和卒中指标的数据。记录改良 Rankin 量表（mRS）在 1 个月时的评分，分为良好（mRS≤2）和不良（mRS≥5）结局。计算 DRAGON 和 MRI-DRAGON 评分。建立 S-TPI 模型。计算每个预后模型的接收者操作特征曲线（ROC）下面积（AUC）及其 95%置信区间。
本研究共纳入 279 例患者。其中，43%（n=119）为男性。中位年龄（四分位距[IQR]）为 69（57-80）岁。入院时 NIHSS（IQR）为 7（4-13）。12%的队列（n=34）为后循环卒中。1 个月时，66%的患者（n=185）mRS≤2，14%的患者（n=39）mRS≥5。MRI-DRAGON 在预测良好（AUC=0.86，95%CI：0.81-0.90）和不良结局（AUC=0.84，95%CI：0.76-0.91）方面具有最高的准确性。DRAGON 也表现出对良好（AUC=0.85，95%CI：0.80-0.89）和不良（AUC=0.82，95%CI：0.75-0.90）结局的高准确性。相反，在我们的人群中，S-TPI 模型对良好（AUC=0.56，95%CI：0.49-0.63）和不良（AUC=0.68，95%CI：0.61-0.76）结局的准确性最低。
在可用的分级评分中，MRI-DRAGON 评分可被视为 rtPA 治疗的农村卒中患者更准确的短期预后工具。
