Published online before print December 5, 2002, doi: 10.1161/01.STR.0000047102.61863.E3
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2003;34:200.)
© 2003 American Heart Association, Inc.
Short Communication |
Predicting Outcome in Ischemic Stroke
External Validation of Predictive Risk Models
From the Departments of Neurology (K.C.J., E.C.H.) and Health Evaluation Sciences (K.C.J., A.F.C., D.P.W.), University of Virginia, Charlottesville.
Correspondence to Karen C. Johnston, MD, University of Virginia Health System, Department of Neurology, #800394, Charlottesville, VA 22908. E-mail kj4v{at}virginia.edu
Abstract
Background— Six multivariable models predicting 3-month outcome of acute ischemic stroke have been developed and internally validated previously. The purpose of this study was to externally validate the previous models in an independent data set.
Summary of Report— We predicted outcomes for 299 patients with ischemic stroke who received placebo in the National Institute of Neurological Disorders and Stroke rt-PA trial. The model equations used 6 acute clinical variables and head CT infarct volume at 1 week as independent variables and 3-month National Institutes of Health Stroke Scale, Barthel Index, and Glasgow Outcome Scale as dependent variables. Previously developed model equations were used to forecast excellent and devastating outcome for subjects in the placebo tissue plasminogen activator data set. Area under the receiver operator characteristic curve was used to measure discrimination, and calibration charts were used to measure calibration. The validation data set patients were more severely ill (National Institutes of Health Stroke Scale and infarct volume) than the model development subjects. Area under the receiver operator characteristic curves demonstrated remarkably little degradation in the validation data set and ranged from 0.75 to 0.89. Calibration curves showed fair to good calibration.
Conclusions— Our models have demonstrated excellent discrimination and acceptable calibration in an external data set. Development and validation of improved models using variables that are all available acutely are necessary.
Key Words: cerebral ischemia • models, statistical • prognosis • stroke outcome
This article has been cited by other articles:
 |
|
 |
|
  P. Khatri, T. Abruzzo, S. D. Yeatts, C. Nichols, J. P. Broderick, T. A. Tomsick, and For the IMS I and II Investigators Good clinical outcome after ischemic stroke with successful revascularization is time-dependent Neurology, September 29, 2009; 73(13): 1066 - 1072. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L.E. Cipriano, M.L. Steinberg, G.S. Gazelle, and R.G. Gonzalez Comparing and Predicting the Costs and Outcomes of Patients with Major and Minor Stroke Using the Boston Acute Stroke Imaging Scale Neuroimaging Classification System AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 703 - 709. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Kissela, C. J. Lindsell, D. Kleindorfer, K. Alwell, C. J. Moomaw, D. Woo, M. L. Flaherty, E. Air, J. Broderick, and J. Tsevat Clinical Prediction of Functional Outcome After Ischemic Stroke: The Surprising Importance of Periventricular White Matter Disease and Race Stroke, February 1, 2009; 40(2): 530 - 536. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Uyttenboogaart, R E Stewart, P C Vroomen, G-J Luijckx, and J De Keyser Utility of the stroke-thrombolytic predictive instrument J. Neurol. Neurosurg. Psychiatry, September 1, 2008; 79(9): 1079 - 1081. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H F Lingsma, D W J Dippel, S E Hoeks, E W Steyerberg, C L Franke, R J van Oostenbrugge, G de Jong, M L Simoons, W J M Scholte op Reimer, and The Netherlands Stroke Survey investigators Variation between hospitals in patient outcome after stroke is only partly explained by differences in quality of care: results from the Netherlands Stroke Survey J. Neurol. Neurosurg. Psychiatry, August 1, 2008; 79(8): 888 - 894. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. R. Konig, A. Ziegler, E. Bluhmki, W. Hacke, P. M.W. Bath, R. L. Sacco, H. C. Diener, C. Weimar, and on behalf of the Virtual International Stroke Tria Predicting Long-Term Outcome After Acute Ischemic Stroke: A Simple Index Works in Patients From Controlled Clinical Trials Stroke, June 1, 2008; 39(6): 1821 - 1826. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Khatri, R. A. Taylor, V. Palumbo, V. Rajajee, J. M. Katz, J. A. Chalela, A. Geers, J. Haymore, D. M. Kolansky, S. E. Kasner, et al. The safety and efficacy of thrombolysis for strokes after cardiac catheterization. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 906 - 911. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. C. Johnston, D. P. Wagner, X.-Q. Wang, G. C. Newman, V. Thijs, S. Sen, S. Warach, and for the GAIN, Citicoline, and ASAP Investigators Validation of an Acute Ischemic Stroke Model: Does Diffusion-Weighted Imaging Lesion Volume Offer a Clinically Significant Improvement in Prediction of Outcome? * Definitions and Explanations Stroke, June 1, 2007; 38(6): 1820 - 1825. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.S.V. Elkind, S. Prabhakaran, J. Pittman, W. Koroshetz, M. Jacoby, K. C. Johnston, and for the GAIN Americas Investigators Sex as a predictor of outcomes in patients treated with thrombolysis for acute stroke Neurology, March 13, 2007; 68(11): 842 - 848. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
German Stroke Study Collaboration Predicting outcome after acute ischemic stroke: An external validation of prognostic models Neurology, February 24, 2004; 62(4): 581 - 585. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Weimar, I.R. Konig, K. Kraywinkel, A. Ziegler, and H.C. Diener Age and National Institutes of Health Stroke Scale Score Within 6 Hours After Onset Are Accurate Predictors of Outcome After Cerebral Ischemia: Development and External Validation of Prognostic Models Stroke, January 1, 2004; 35(1): 158 - 162. [Abstract] [Full Text] [PDF]
|
|