מתוך medicontext.co.il
By Michelle Cooke
WESTPORT, CT (Reuters Health) – A fast and simple prognostic index can improve the ability of clinicians to predict 30-day mortality after acute ischemic stroke in the hospital setting, according to a report in the August issue of the Journal of Clinical Epidemiology.
"When a patient comes to a doctor, the patient and the relatives…usually like to know their chance of recovery or death," first author, Dr. Yang Wang told Reuters Health. "By using the prognostic index, clinicians will be more confident to say, [for example], that a patient with a score of 11 will have a 75% chance of death."
Dr. Wang, a researcher at Royal Newcastle Hospital in New South Wales, and colleagues in Australia, developed a simple prognostic index and validated it in a total of 440 patients with a diagnosis of acute ischemic stroke.
The patients, who were recruited from a single teaching hospital in the Hunter Region of Australia between July 1995 and June 1997, were randomly assigned a derivation or a validation group. "The derivation sample was used to develop a prediction model," they explain, and "the validation sample was used to test the validity of the prediction model."
Using the clinical characteristics and outcomes of the derivation sample, the team designed a 16-point prognostic index based on impaired consciousness (5 points), dysphagia (3 points), urinary incontinence (4 points), admission body temperature above 36.5 degrees Celsius (2 points) and hyperglycemia without a history of diabetes (2 points).
A score of 11 points was the optimal cutoff point for the index. Patients with a score below 11 were at low risk of 30-day mortality, with a death rate of only 3%. Those with scores of or higher 11 were designated the high risk group, in whom 30-day mortality was 75%.
The sensitivity, specificity and positive predictive value of the prognostic index were 68%, 98% and 75%, respectively, in the derivation group, and 57%, 97% and 68%, respectively, in the validation group.
While other prognostic indices for 30-day mortality after stroke exist, "most of them are complicated," Dr. Wang told Reuters Health. "They can be used for scientific research, but [are] less likely to be used in routine clinics." The new index is appropriate for the latter setting, since it is simple and utilizes information that is available at the first patient contact.
Dr. Wang noted that the index can be used to identify patients in need of more aggressive interventions, as well as those with the greatest chances of disability or death.
J Clin Epidemiol 2001;54:766-773
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