22. European Stroke Conference 563 Acute stroke: emergency management, stroke units and complications Simple variables predict miserable outcome after IV-thrombolysis D.J. Seiffge1, A. Karagiannis2, D. Strbian3, H. Gensicke4, N. Peters5, L.H. Bonati6, K. Kotisaari7, M. Leppä8, J. Kejda-Scharler9, C. Schindler10, T. Tatlitsumak11, P. Lyrer12, S. Engelter13 Department of Neurology and Stroke Unit, Univeristy Hospital, Basel, Basel, SWITZER-LAND1, Swiss Tropical and Public Health Institute, Basel and University of Basel, Basel, SWIT-ZERLAND2, Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND3, Department of Neurology and Stroke Unit, Univeristy Hospital, Basel, Basel, SWITZERLAND4, Department of Neurology and Stroke Unit, Univeristy Hospital, Basel, , 5, Department of Neurology and Stroke Unit, Univeristy Hospital, Basel, , 6, Department of Neurology, Helsinki University Cen-tral Hospital, Helsinki, FINLAND7, Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND8, Department of Neurology and Stroke Unit, Univeristy Hospital, Basel, Basel, SWITZERLAND9, Swiss Tropical and Public Health Institute, Basel and University of Basel, Basel, SWITZER-LAND10, Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND11, Department of Neurology and Stroke Unit, Univeristy Hospital, Basel, Basel, SWITZERLAND12, Department of Neurology and Stroke Unit, Univeristy Hospital, Basel, Basel, SWITZERLAND13 Background: Early identification of patients unlikely to benefit from IV thrombolysis alone is essential for plan-ning additional therapeutic measures. The aim of this study was to test the predictability of miser-able outcome among stroke patients receiving IV thrombolysis (IVT) based on a simple variables model (SVM) and to compare the model’s predictive performance with the DRAGON-score (i.e., “Dense cerebral artery sign/early infarct signs on CT”, “pre-stroke mRS”, “Age”, “blood Glucose”, “Onset-to-treatment time” and “baseline National institutes of Health Stroke Scale score NIHSS”) Methods: The SVM consists of the parameters “age”, “independent before stroke”, “normal Glasgow coma verbal score”, “able to lift arms” and “able to walk”. In a derivation cohort of 1346 and a validation cohort of 638 consecutive IVT-treated stroke patients, we compared prediction of miserable 3-month outcome defined as modified Rankin scale score (mRS) of 5-6 with the SVM compared to prediction with the DRAGON score. Area under the computed-receiver-operating curves (AUC-ROC; 95% Confidence intervals) were used to compare the predictive values. Results: AUC-ROCs to predict miserable outcome with the SVM were 80.7 (95% CI: 77.5-83.8) in the der-ivation cohort and 78.6 (74.2-82.9) in the validation cohort and for the DRAGON score 82.2(79.0- 85.0)/80.9(77.4-84.5) in the derivation/validation cohort (p>0.05 for all comparisons). Conclusion: The SVM was similarly accurate as the DRAGON score to predict miserable outcome after IVT. As these simple variables are available already at the pre-hospital stage, the SVM may facilitate and accelerate triage of patients at high risk for miserable outcome after IVT towards more invasive add-on treatments. 642 © 2013 S. Karger AG, Basel Scientific Programme 564 Acute stroke: emergency management, stroke units and complications External validation of the SEDAN score for prediction of intracerebral hemorrhage in stroke thrombolysis. M.V. Mazya1, P. Bovi2, J. Castillo3, D. Jatuzis4, A. Kobayashi5, N. Wahlgren6, N. Ahmed7 Department of Neurology, Karolinska University Hospital, Stockholm, SWEDEN1, UO di Neu-rologia, Azienda Ospedaliera;Universitaria di Verona, Verona, ITALY2, Department of Neurology, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, University of Santia-go de Compostela, Santiago de Compostela, SPAIN3, Department of Neurology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, 4, 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, POLAND5, Department of Neurology, Karolinska University Hospital, Stock-holm, SWEDEN6, Department of Neurology, Karolinska University Hospital, Stockholm, SWE-DEN7 Background: The SEDAN score is a prediction rule for assessment of the risk of symptomatic intra-cerebral hemorrhage (SICH) per the ECASS II definition in acute ischemic stroke patients treated with intravenous thrombolysis. We assessed the performance of the score in predicting SICH per the ECASS II and SITS-MOST definitions in the SITS International Stroke Thrombolysis Register (ISTR). Methods: We calculated the SEDAN score in 34251 patients with complete data, enrolled into the SITS ISTR. The risk for SICH by both definitions was calculated per score category. Odds ratios (OR) for SICH per one-point increase of the score were obtained using logistic regression. The predictive performance was assessed using AUC-ROC. Results: The predictive capability for SICH per ECASS II was moderate at AUC-ROC 0.66. With rising scores, there was a moderate in-crease in risk for SICH per ECASS II (OR 1.65 per point, 95% CI 1.59-1.72, p<0.001), with SICH rates between 1.6% for 0 points and 16.9% for ≥5 points, average 5.1%. The predictive capability for SICH per SITS-MOST was weaker, AUC-ROC 0.60, with lower increase per score point (OR 1.36 per point, 95% CI 1.28-1.46, p<0.001), and SICH rates between 0.8% for 0 points and 5.4% for ≥5 points, average 1.8%. Conclusions: In this very large dataset, the predictive and discriminatory performance of the SEDAN score was only moderate for SICH per ECASS II and low for SICH per SITS-MOST.
Karger_ESC London_2013
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