The Art of Estimating Outcomes and Treating Patients With Stroke in the 21st Century
- decision making
- disability evaluation health policy
- outcome assessment (health care)
Will the future bring your wisdom to me? Or will darkness rule the kingdom for all eternity?...
—Michel de Nostredame, known as Nostradamus (1503–1566)
See related article, p 1689.
Clinicians, patients, and their families usually inquire about an expected outcome after an acute event, the response to thrombolysis, and endovascular therapy. Some clinicians use their past experience or weight risk factors known to influence stroke outcomes. These factors can be categorized as follows: (1) patient-level factors (eg, age, stroke severity, comorbid conditions), (2) physician-level factors (eg, specialty, years of experience), and (3) institutional-level factors (eg, Joint Commission on Accreditation of Healthcare Organizations affiliation, stroke center, annual volume of stroke admissions).1,2
The development of novel diagnostic tests (ie, computed tomographic perfusion, assessment of collateral flow, MRI perfusion), risk prognostic scores (ie, ischemic stroke risk score [iSCORE], stroke prognostication using age and NIHSS-100 [SPAN-100], totaled health risks in vascular events [THRIVE], sugar, early infarct signs, dense cerebral artery sign, age, and NIH stroke scale [SEDAN], among others; Table), and therapeutic opportunities (ie, new agents for intravenous/intra-arterial thrombolysis, new catheters for endovascular treatment) provide relevant information when discussing and counseling patients with stroke and their families. Currently, there are several stroke risk prognostic scores to predict different outcome measures, including early- and long-term mortality, disability, discharge disposition, response to tissue-type plasminogen activator, and risk of intracerebral hemorrhage after thrombolysis (Figure).3–8 When applied to large populations, risk scores can provide useful prognostic estimates.