The PLAN Score: A Bedside Prediction Rule for Death and Severe Disability Following Acute Ischemic Stroke | Cerebrovascular Disease | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.236.187.155. Please contact the publisher to request reinstatement.
1.
Donnan GA, Fisher M, Macleod M, Davis SM. Stroke.  Lancet. 2008;371(9624):1612-162318468545PubMedGoogle ScholarCrossref
2.
Counsell C, Dennis M. Systematic review of prognostic models in patients with acute stroke.  Cerebrovasc Dis. 2001;12(3):159-17011641579PubMedGoogle ScholarCrossref
3.
Kalra L, Crome P. The role of prognostic scores in targeting stroke rehabilitation in elderly patients.  J Am Geriatr Soc. 1993;41(4):396-4008463526PubMedGoogle Scholar
4.
Kalra L, Dale P, Crome P. Evaluation of a clinical score for prognostic stratification of elderly stroke patients.  Age Ageing. 1994;23(6):492-4989231944PubMedGoogle ScholarCrossref
5.
Gompertz P, Pound P, Ebrahim S. Predicting stroke outcome: Guy's prognostic score in practice.  J Neurol Neurosurg Psychiatry. 1994;57(8):932-9358057116PubMedGoogle ScholarCrossref
6.
Baird AE, Dambrosia J, Janket S,  et al.  A three-item scale for the early prediction of stroke recovery.  Lancet. 2001;357(9274):2095-209911445104PubMedGoogle ScholarCrossref
7.
Inouye M. Predicting outcomes of patients in Japan after first acute stroke using a simple model.  Am J Phys Med Rehabil. 2001;80(9):645-64911523966PubMedGoogle ScholarCrossref
8.
Counsell C, Dennis M, McDowall M, Warlow C. Predicting outcome after acute and subacute stroke: development and validation of new prognostic models.  Stroke. 2002;33(4):1041-104711935058PubMedGoogle ScholarCrossref
9.
Weimar C, Ziegler A, König IR, Diener HC. Predicting functional outcome and survival after acute ischemic stroke.  J Neurol. 2002;249(7):888-89512140674PubMedGoogle ScholarCrossref
10.
Johnston KC, Connors AF Jr, Wagner DP, Haley EC Jr. Predicting outcome in ischemic stroke: external validation of predictive risk models.  Stroke. 2003;34(1):200-20212511774PubMedGoogle ScholarCrossref
11.
Wang Y, Lim LL, Heller RF, Fisher J, Levi CR. A prediction model of 1-year mortality for acute ischemic stroke patients.  Arch Phys Med Rehabil. 2003;84(7):1006-101112881825PubMedGoogle ScholarCrossref
12.
Kent DM, Selker HP, Ruthazer R, Bluhmki E, Hacke W. The stroke-thrombolytic predictive instrument: a predictive instrument for intravenous thrombolysis in acute ischemic stroke.  Stroke. 2006;37(12):2957-296217068305PubMedGoogle ScholarCrossref
13.
Solberg OG, Dahl M, Mowinckel P, Stavem K. Derivation and validation of a simple risk score for predicting 1-year mortality in stroke.  J Neurol. 2007;254(10):1376-138317934885PubMedGoogle ScholarCrossref
14.
Reid JM, Gubitz GJ, Dai D,  et al.  External validation of a six simple variable model of stroke outcome and verification in hyper-acute stroke.  J Neurol Neurosurg Psychiatry. 2007;78(12):1390-139118024695PubMedGoogle ScholarCrossref
15.
Lewis SC, Sandercock PA, Dennis MS.SCOPE (Stroke Complications and Outcomes Prediction Engine) Collaborations; IST.  Predicting outcome in hyper-acute stroke: validation of a prognostic model in the Third International Stroke Trial (IST3).  J Neurol Neurosurg Psychiatry. 2008;79(4):397-40017766429PubMedGoogle ScholarCrossref
16.
Birkner MD, Kalantri S, Solao V,  et al.  Creating diagnostic scores using data-adaptive regression: an application to prediction of 30-day mortality among stroke victims in a rural hospital in India.  Ther Clin Risk Manag. 2007;3(3):475-48418488068PubMedGoogle Scholar
17.
König IR, Ziegler A, Bluhmki E,  et al; Virtual International Stroke Trials Archive (VISTA) Investigators.  Predicting long-term outcome after acute ischemic stroke: a simple index works in patients from controlled clinical trials.  Stroke. 2008;39(6):1821-182618403738PubMedGoogle ScholarCrossref
18.
Reid JM, Gubitz GJ, Dai D,  et al.  Predicting functional outcome after stroke by modelling baseline clinical and CT variables.  Age Ageing. 2010;39(3):360-36620233732PubMedGoogle ScholarCrossref
19.
Smith EE, Shobha N, Dai D,  et al.  Risk score for in-hospital ischemic stroke mortality derived and validated within the Get With the Guidelines–Stroke Program.  Circulation. 2010;122(15):1496-150420876438PubMedGoogle ScholarCrossref
20.
Saposnik G, Kapral MK, Liu Y,  et al; Investigators of the Registry of the Canadian Stroke Network; Stroke Outcomes Research Canada (SORCan) Working Group.  IScore: a risk score to predict death early after hospitalization for an acute ischemic stroke.  Circulation. 2011;123(7):739-74921300951PubMedGoogle ScholarCrossref
21.
Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation.  JAMA. 2001;285(22):2864-287011401607PubMedGoogle ScholarCrossref
22.
Chandratheva A, Mehta Z, Geraghty OC, Marquardt L, Rothwell PM.Oxford Vascular Study.  Population-based study of risk and predictors of stroke in the first few hours after a TIA.  Neurology. 2009;72(22):1941-194719487652PubMedGoogle ScholarCrossref
23.
Fang MC, Go AS, Chang Y, Borowsky L, Pomernacki NK, Singer DE.ATRIA Study Group.  Comparison of risk stratification schemes to predict thromboembolism in people with nonvalvular atrial fibrillation.  J Am Coll Cardiol. 2008;51(8):810-81518294564PubMedGoogle ScholarCrossref
24.
Karthikeyan G, Eikelboom JW. The CHADS2 score for stroke risk stratification in atrial fibrillation—friend or foe?  Thromb Haemost. 2010;104(1):45-4820458437PubMedGoogle ScholarCrossref
25.
Tsivgoulis G, Heliopoulos I. Potential and failure of the ABCD2 score in stroke risk prediction after transient ischemic attack.  Stroke. 2010;41(5):836-83820299665PubMedGoogle ScholarCrossref
26.
Kapral MK, Silver FL, Richards JA,  et al.  Registry of the Canadian Stroke Network: Progress Report 2001–2005. Toronto, ON: Institute for Clinical Evaluative Sciences; 2005
27.
Côté R, Battista RN, Wolfson C, Boucher J, Adam J, Hachinski V. The Canadian Neurological Scale: validation and reliability assessment.  Neurology. 1989;39(5):638-6432710353PubMedGoogle ScholarCrossref
28.
Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model.  JAMA. 2003;290(19):2581-258714625335PubMedGoogle ScholarCrossref
29.
Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors.  Stat Med. 1996;15(4):361-3878668867PubMedGoogle ScholarCrossref
30.
Hosmer DW, Lemeshow S. Applied Logistic Regression. 2nd ed. New York, NY: John Wiley & Sons Inc; 2000
31.
Spilker J, Kongable G, Barch C,  et al; NINDS rt-PA Stroke Study Group.  Using the NIH Stroke Scale to assess stroke patients.  J Neurosci Nurs. 1997;29(6):384-3929479660PubMedGoogle ScholarCrossref
32.
Ohman EM, Granger CB, Harrington RA, Lee KL. Risk stratification and therapeutic decision making in acute coronary syndromes.  JAMA. 2000;284(7):876-87810938178PubMedGoogle ScholarCrossref
33.
Kissela B, Lindsell CJ, Kleindorfer D,  et al.  Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race.  Stroke. 2009;40(2):530-53619109548PubMedGoogle ScholarCrossref
34.
O’Donnell MJ, Xavier D, Liu L,  et al; INTERSTROKE investigators.  Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study.  Lancet. 2010;376(9735):112-12320561675PubMedGoogle ScholarCrossref
35.
Nijland RH, van Wegen EE, Harmeling-van der Wel BC, Kwakkel G.EPOS Investigators.  Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery: early prediction of functional outcome after stroke: the EPOS cohort study.  Stroke. 2010;41(4):745-75020167916PubMedGoogle ScholarCrossref
36.
Rost NS, Smith EE, Chang Y,  et al.  Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score.  Stroke. 2008;39(8):2304-230918556582PubMedGoogle ScholarCrossref
37.
Weimar C, Benemann J, Diener HC.German Stroke Study Collaboration.  Development and validation of the Essen Intracerebral Haemorrhage Score.  J Neurol Neurosurg Psychiatry. 2006;77(5):601-60516354736PubMedGoogle ScholarCrossref
38.
Samsa GP, Matchar DB, Goldstein L,  et al.  Utilities for major stroke: results from a survey of preferences among persons at increased risk for stroke.  Am Heart J. 1998;136(4, pt 1):703-7139778075PubMedGoogle ScholarCrossref
Original Investigation
Nov 12, 2012

The PLAN Score: A Bedside Prediction Rule for Death and Severe Disability Following Acute Ischemic Stroke

Author Affiliations

Author Affiliations: Health Research Board Clinical Research Facility, Geata an Eolais, National University of Ireland, Galway, Ireland (Drs O’Donnell and McGrath); Institute for Clinical Evaluative Sciences (ICES) (Drs Fang, Saposnik, and Kapral) and Departments of Neurology (Dr Saposnik) and Medicine (Dr Kapral), University of Toronto, Toronto, Ontario, Canada; Division of Geriatrics, Joseph Brant Hospital, Burlington, Ontario, Canada (Ms D’Uva); and Division of Neurology, Hamilton Health Sciences, Hamilton, Ontario, Canada (Ms Gould).

Arch Intern Med. 2012;172(20):1548-1556. doi:10.1001/2013.jamainternmed.30
Abstract

Background We sought to develop and validate a simple clinical prediction rule for death and severe disability after acute ischemic stroke that can be used by general clinicians at the time of hospital admission.

Methods We analyzed data from a registry of 9847 patients (4943 in the derivation cohort and 4904 in the validation cohort) hospitalized with acute ischemic stroke and included in the Registry of the Canadian Stroke Network (July 1, 2003, to March 31, 2008; 11 regional stroke centers in Ontario, Canada). Outcome measures were 30-day and 1-year mortality and a modified Rankin score of 5 to 6 at discharge.

Results Overall 30-day mortality was 11.5% (derivation cohort) and 13.5% (validation cohort). In the final multivariate model, we included 9 clinical variables that could be categorized as preadmission comorbidities (5 points for preadmission dependence [1.5], cancer [1.5], congestive heart failure [1.0], and atrial fibrillation [1.0]), level of consciousness (5 points for reduced level of consciousness), age (10 points, 1 point/decade), and neurologic focal deficit (5 points for significant/total weakness of the leg [2], weakness of the arm [2], and aphasia or neglect [1]). Maximum score is 25. In the validation cohort, the PLAN score (derived from preadmission comorbidities, level of consciousness, age, and neurologic deficit) predicted 30-day mortality (C statistic, 0.87), death or severe dependence at discharge (0.88), and 1-year mortality (0.84). The PLAN score also predicted favorable outcome (modified Rankin score, 0-2) at discharge (C statistic, 0.80).

Conclusions The PLAN clinical prediction rule identifies patients who will have a poor outcome after hospitalization for acute ischemic stroke. The score comprises clinical data available at the time of admission and may be determined by nonspecialist clinicians. Additional studies to independently validate the PLAN rule in different populations and settings are required.

×