The PLAN Score: A Bedside Prediction Rule for Death and Severe Disability Following Acute Ischemic Stroke | Cerebrovascular Disease | JAMA Internal Medicine | JAMA Network
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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

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.