The role of prognostic scores in targeting stroke rehabilitation in elderly patients.

OBJECTIVE

To determine the validity of clinically derived prognostic scores in targeting stroke rehabilitation in elderly patients.

DESIGN, SETTING AND PARTICIPANTS: One-year prospective cohort study in 96 hospitalized stroke patients over 75 years of age from a well defined geographical area.

MEASUREMENTS

Edinburgh prognostic score (incorporating measures of motor deficit, proprioception, and power), Orpington prognostic score (Edinburgh score modified to include a measure of cognition), and Barthel ADL scores were measured at 1, 2, and 4 weeks after stroke. These scores were correlated with outcome and patients' Barthel ADL score at discharge or at 16 weeks if still in hospital.

RESULTS

Edinburgh prognostic score measured at 2 weeks correlated significantly with Barthel ADL score at discharge or at 16 weeks (r2 = 0.57, P < 0.001), and Orpington prognostic scores showed greater correlation (r2 = 0.89 vs 0.57), especially in patients with dementia (r2 = 0.81 vs 0.39). Barthel ADL scores at 2 weeks showed a weak correlation with Barthel ADL scores at discharge or 16 weeks (r2 = 0.58). Patients with Orpington Score < 3.2 were discharged within 3 weeks of stroke, whereas those scoring > 5.2 required long-term care. Most patients (90%) with Orpington Score of 3-5 were eventually discharged home although this was not always apparent on initial clinical assessment at the time of admission.

CONCLUSIONS

The Orpington score when assessed at 2-weeks post-stroke is a useful prognostic indicator with special suitability for the elderly and may help to select patients most likely to benefit from stroke unit rehabilitation.