Complications and prognosis

There are nearly 800,000 cases of acute stroke in the United States every year, with 130,000
associated deaths (4th leading cause of death in Americans). 20% show immediate mortality
and 70% have some degree of disability. Early management is important since recurrence of
stroke occurs at a rate of about 10% per year in untreated patients. 50-70% of patients
regain independence and up to 80% regain the ability to walk again (Braillman, 2005).

Severely affected patients, e.g. immobilized with dense hemiplegia, are prone to
complications that may lead to early death, including pneumonia (over 50% of stroke patients
are acutely dysphagic, with a risk of aspiration, though swallowing recovers spontaneously in
most patients), septicaemia (via pressure sores or urinary tract infection), deep vein
thrombosis and pulmonary embolism, myocardial infarction, arrhythmias and heart failure,
fluid imbalance. Approximately 10% of patients with cerebral infarction die in the first 30
days. Up to 50% of survivors remain dependent. Factors contributing to long-term disability
include pressure sores and epilepsy (Ginsberg, 2000).

The THRIVE score can help physicians predict functional outcome, death after stroke, and the
risk of brain hemorrhage after IV tPA administration in patients who suffer an ischemic stroke.
The THRIVE score can help physicians predict several key outcomes in patients suffering an
ischemic stroke

Table 1. Thrive Score

Criteria Value
NIH Stroke Scale
≤ 10 0
11-20 +2
≥ 21 +4
Age
≤ 59 0
60-79 +1
≥ 80 +2
History
Hypertension +1
Diabetes mellitus +1
Atrial fibrillation +1

The THRIVE score was derived after analysing data from two single-arm trials of
subjects with ischemic stroke who were treated with a thrombectomy device. The 0-9 point
score was found to be strongly predictive of neurological outcome (as measured by the
Modified Rankin Score) and mortality at 90 days. (Flint, 2010) The THRIVE score was
subsequently validated after being applied a prospectively collected database registry of 1000
patients who underwent endovascular thrombectomy for acute ischemic stroke. (Flint, 2012)
The THRIVE score was then applied to data from the NINDS trials and was found to be a
better predictor of outcomes than NIHSS and age alone. (Kamel, 2012) When applied to the
the data for the 6483 subjects in the Safe Implementation of Thrombolysis in Stroke -
Monitoring Study (SITS-MOST), the THRIVE score was found to predict the risk of
symptomatic intracranial hemorrhage after intravenous tPA administration. (Flint, 2014)
 The National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS) is a tool
used by healthcare providers to objectively quantify the impairment caused by a stroke. The
NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4.
For each item, a score of 0 typically indicates normal function in that specific ability, while a
higher score is indicative of some level of impairment. The individual scores from each item
are summed in order to calculate a patient's total NIHSS score. The maximum possible score
is 42, with the minimum score being a 0.

o Level of Consciousness
 LOC Responsiveness
 LOC Questions
 LOC Commands
o Horizontal Eye Movement
o Visual field test
o Facial Palsy
o Motor Arm
o Motor Leg
o Limb Ataxia
o Sensory
o Language
o Speech
o Extinction and Inattention
Table 2. NIH Stroke Scale (NIHSS) scoring
Score Stroke severity
0 No stroke symptoms
1-4 Minor stroke
5-15 Moderate stroke
16-20 Moderate to severe stroke
21-42 Severe stroke

Results of the patient yield 2 points thrive score which is equal to a 74% good outcome

References:
 Ginsberg, Lionel (2000). Lecture Notes: Neurology
 Braillman, Jon (2005). In a Page: Neurology.
 Flint AC, Cullen SP, Faigeles BS, Rao VA. Predicting long-term outcome after
endovascular stroke treatment: the totaled health risks in vascular events score.
AJNR Am J Neuroradiol. 2010 Aug;31(7):1192-6. doi: 10.3174/ajnr.A2050. Epub
2010 Mar 11. PubMed PMID: 20223889.
 Kamel H, Patel N, Rao VA, Cullen SP, Faigeles BS, Smith WS, Flint AC. The Totaled
Health Risks in Vascular Events (THRIVE) Score Predicts Ischemic Stroke Outcomes
Independent of Thrombolytic Therapy in the NINDS tPA Trial. J Stroke Cerebrovasc
Dis. 2012 Nov 2. doi:pii: S1052-3057(12)00311-4.
10.1016/j.jstrokecerebrovasdis.2012.08.017. [Epub ahead of print] PubMed PMID:
23122722.