Prognostication in acute cerebrovascular disease. Subjective assessment and test of a prognostic score.

Subjective assessment of the short-term outcome and functional state at discharge was made shortly after admission in 200 consecutive patients with acute cerebrovascular disease (CVD) treated in a stroke unit. The assessments proved correct in 59% of the patients. The accuracy of the predictions was not significantly better in patients with a correct preliminary disanosis than in those with a false. When a known prognostic score for prediction of hospital mortality was tested on 179 of the patients with cerebral haemorrhage or infarction, a correct trend was noted. The score was best applicable in patients with serious symptoms and those with only minor deficit on admission. A high sensitivity of the score was combined with a relatively low specificity. A true comparison between the predictive value of the score and the quality of the subjective assessments was difficult as the latter, in addition to prediction of mortality, also included predicton of the patient's functional state at discharge. The degree of neurological deficit rather than the type of cerebrovascular lesion seemed associated with the short-term outcome. Improvement of the quality of prognostic assessments in CVD is warranted.