An integer-based

score to
predict
functional jr5in acute
ischemic stroke
The ASTRAL score
Neurology 78 June 12, 2012 1917

Objective
: To develop and validate a simple,
integer-based score to predict
functional outcome in
acute ischemic stroke (AIS) using variables
readily available after emergency room
admission.

prediction of stroke
outcome
stroke physicians in treatment
realistic prognostic expectations and to
plan the long-term living setting.
nonrandomized studies to control for casemix variation
controlled clinical trials as a selection
criterion.

ASTRAL SCORE
Age (A),
severity of stroke (S) measured by
admission NIH Stroke Scale score,
Stroke onset to admission time (T),
range of visual fields (R),
acute glucose (A),
level of consciousness(L)

METHODS
The prognostic score was developed in a cohort
of patients from the Acute Stroke Registry
: age, gender, onset to admission time,
prestroke mRS score,
the type of clinical deficit according to the NIH Stroke
Scale (NIHSS) score,
the absolute NIHSS score at admission,
vascular territory and
localization of the stroke by TOAST
cardiovascular risk factors
and comorbidities, prestroke medication,

The following covariates were

included in the multivariate analysis
: age, gender, onset to admission Time
,
prestroke mRS score,
the type of clinical deficit accordin gto the NIH Stroke
Scale (NIHSS) score
, the absolute NIHSSscore at admission,
vascular territord
localization of the
\\Treatment (TOAST) mechanism,11 cardiovascular risk
factors
and comorbidities, prestroke medication, basic findings
on
brain imaging at admission (noncontrast CT or T2 or

Covariates Score points

Age: for every 5 ya
1
Severity: for every NIHSS pointa 1
Time delay from onset to admission >3
hb 2
Range of visual field defectc 2
Acute glucose >7.3 or <3.7 mmol/Ld
1
Level of consciousness decreasede
3

Six covariates were identified as

independent
predictors of unfavorable outcome in
multiple
logistic regression analysis: age, NIHSS
score at ad mission, delay from stroke onset to
admission, visual
field defect, glucose at admission, and
impaired level of
consciousness

RESULTS

The median score value was 23(range 5-63)

DISCUSSION
can be assessed in the
emergency room to predict ischemic stroke
outcome
that time to admission is
an independent predictor of outcomeat 3
months in patients arriving within 24 hours

that time to admission is

an independent predictor of outcome

that time to admission is

an independent predictor of outcome

the ASTRAL score in its

current form does not require information
from
brain imaging (other than excluding
intracerebral
hemorrhage,
It was derived from a large registry of
consecutive patients
and has performed well during external
validation
in 2 independent large stroke registries

The use of the ASTRAL score as a

selection criterion could help identify and recruit
those patients who would have an increased likelihood
of achieving a positive result; the rapid and easy
(especially with the use of the color chart) calculation
of the score at an early stage such as hospital
admission
emphasizes the feasibility of use of the ASTRAL
score as a selection tool for recruitment of patients in
randomized clinical trials

Thank you