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(Stroke. 2008;39:1665.)
© 2008 American Heart Association, Inc.

Editorials

Predictions Models in Acute Stroke

Potential Uses and Limitations

Martin Dennis, MD

From the Neurosciences Trials Unit, Division of Clinical Neurosciences, Western General Hospital, Edinburgh, Scotland, UK.

Correspondence to Prof Martin Dennis, Neurosciences Trials Unit, Division of Clinical Neurosciences, Western General Hospital, Edinburgh, Scotland, UK, EH4 2XU. E-mail martin.dennis@ed.ac.uk

Key Words: prognosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 1821–1826.

Konig et al¹ report an external validation of their simple prediction model in patients with acute ischemic stroke enrolled into several randomized trials participating in the VISTA collaboration. Their model includes just age and the total NIHSS score and predicts survival and survival with functional recovery (Barthel Index 95) at 90 days. They report reasonable predictive accuracy which is slightly improved if they "tweak" their model. This improvement is predictable because models almost always perform best in the cohort in which they were derived and less well in independent external validation. By tweaking their model they have in effect derived a new model in their validation cohort. The true test is whether their tweaked model performs any better than their original in further independent cohorts.

As the authors point out, theirs’ is the second simple statistical model developed using robust techniques and externally validated in large independent cohorts. The so call "six simple variable (SSV)" model was developed in the Oxfordshire Community Stroke Project (OCSP) and has been externally validated in other community-based,² hospital-based,^2,3 and trial-based⁴ cohorts. This model includes age, dependency and living alone before the stroke and ability to lift arms off the bed, ability to talk normally and ability to walk independently after the stroke. It aims to predict, among other outcomes, survival free of dependency (modified Rankin Scale <3). Unlike the Konig model, it was developed and validated in mixed cohorts of patients, some of whom had prior disability and . . . [Full Text of this Article]

Related Article:

Predicting Long-Term Outcome After Acute Ischemic Stroke: A Simple Index Works in Patients From Controlled Clinical Trials

Inke R. König, Andreas Ziegler, Erich Bluhmki, Werner Hacke, Philip M.W. Bath, Ralph L. Sacco, Hans C. Diener, Christian Weimar on behalf of the Virtual International Stroke Trials Archive (VISTA) Investigators
Stroke 2008 39: 1821-1826. [Abstract] [Full Text] [PDF]