Stroke Alert: A Review of Current Clinical Stroke Literature

By Matthew E. Fink, MD, Interim Chair and Neurologist-in-Chief, Director, Division of Stroke & Critical Care Neurology, Weill Cornell Medical College and New York Presbyterian Hospital

The DRAGON Score: A Measure to Simplify the Prediction of Outcome After IV Thrombolysis

Source: Strbian D, et al. Predicting outcome of IV thrombolysis-treated ischemic stroke patients. The DRAGON score. Neurology 2012;78:427-432.

Of all ischemic stroke patients treated with iv al- teplase (tPA), only about half will achieve recanalization and have a good outcome (mRS 0 to 2). In addition, risk factors for intracerebral hemorrhage and other poor outcomes have been identified and will influence outcomes. The current investigators used known risk factors and applied them to a cohort of 1319 ischemic stroke patients admitted to the Helsinki University Central Hospital, and performed a regression analysis to determine which risk factors had the greatest predictive value. Patients with basilar artery occlusion were excluded. They then developed a score that could be easily based on identifiable risk factors.

The DRAGON score (0–10 points) consists of (hyper)Dense cerebral artery sign/early infarct signs on admission CT scan (both = 2, either = 1, none = 0), prestroke modified Rankin Scale (mRS) score > 1 (yes = 1), Age (> 80 years = 2, 65-79 years = 1, < 65 years = 0), Glucose level at baseline (> 8 mmol/L [> 144 mg/dL] = 1), Onset-to-treatment time (> 90 minutes = 1), and baseline National Institutes of Health Stroke Scale score (> 15 = 3, 10-15 = 2, 5-9 = 1, 0-4 = 0).

Proportions of patients with good outcome (mRS score 0–2) were 96%, 88%, 74%, and 0% for 0-1, 2, 3, and 8-10 points, respectively. Use of this score may aid the decision-making process regarding use of IV tPA or more aggressive intra-arterial therapies.

The SEDAN Score: A Measure to Simplify the Prediction of Intracerebral Hemorrhage After IV Thrombolysis

Source: Strbian D, et al. Symptomatic intracranial hemorrhage after stroke thrombolysis: The SEDAN Score. Ann Neurol 2012: Accepted on-line DOI: 10.1002/ana.23546.

The same lead author, as above, developed a similar scale to help predict the risk of brain hemorrhage after administration of IV tPA. The risk factors were identified in three Swedish cohorts of ischemic stroke patients and regression analysis performed.

The SEDAN score (0 to 6 points) comprises baseline blood Sugar (glucose) [8.1-12.0 mmol/L (145-216 mg/dL)=1; >12.0 mmol/L (> 216 mg/dL) = 2], Early infarct signs (yes = 1) and (hyper)Dense cerebral artery sign (yes = 1) on admission CT scan, Age (> 75 = 1), and NIH Stroke Scale on admission (> 9 = 1). Absolute risk for symptomatic intracranial hemorrhage in the derivation cohort was: 1.4%, 2.9%, 8.5%, 12.2%, 21.7%, and 33.3% for 0, 1, 2, 3, 4, and 5 score points, respectively.

The use of the DRAGON and SEDAN scores may aid the frontline clinician in making rapid decisions regarding thrombolytic therapies in patients with acute ischemic stroke.