ASTRAL, DRAGON and SEDAN scores predict stroke outcome more accurately than physicians

G Ntaios; F Gioulekas; V Papavasileiou; D Strbian; P Michel

doi:10.1111/ene.13100

ASTRAL, DRAGON and SEDAN scores predict stroke outcome more accurately than physicians

Eur J Neurol. 2016 Nov;23(11):1651-1657. doi: 10.1111/ene.13100. Epub 2016 Jul 25.

Authors

G Ntaios¹, F Gioulekas², V Papavasileiou³, D Strbian⁴, P Michel⁵

Affiliations

¹ Department of Medicine, University of Thessaly, Larissa, Greece. gntaios@med.uth.gr.
² Sub-directorate of Informatics, Larissa General University Hospital, Larissa, Greece.
³ Department of Neurosciences, Stroke Service, Leeds Teaching Hospitals NHS Trust and School of Medicine, University of Leeds, Leeds, UK.
⁴ Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
⁵ Stroke Centre, Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.

PMID: 27456206
DOI: 10.1111/ene.13100

Abstract

Background and purpose: ASTRAL, SEDAN and DRAGON scores are three well-validated scores for stroke outcome prediction. Whether these scores predict stroke outcome more accurately compared with physicians interested in stroke was investigated.

Methods: Physicians interested in stroke were invited to an online anonymous survey to provide outcome estimates in randomly allocated structured scenarios of recent real-life stroke patients. Their estimates were compared to scores' predictions in the same scenarios. An estimate was considered accurate if it was within 95% confidence intervals of actual outcome.

Results: In all, 244 participants from 32 different countries responded assessing 720 real scenarios and 2636 outcomes. The majority of physicians' estimates were inaccurate (1422/2636, 53.9%). 400 (56.8%) of physicians' estimates about the percentage probability of 3-month modified Rankin score (mRS) > 2 were accurate compared with 609 (86.5%) of ASTRAL score estimates (P < 0.0001). 394 (61.2%) of physicians' estimates about the percentage probability of post-thrombolysis symptomatic intracranial haemorrhage were accurate compared with 583 (90.5%) of SEDAN score estimates (P < 0.0001). 160 (24.8%) of physicians' estimates about post-thrombolysis 3-month percentage probability of mRS 0-2 were accurate compared with 240 (37.3%) DRAGON score estimates (P < 0.0001). 260 (40.4%) of physicians' estimates about the percentage probability of post-thrombolysis mRS 5-6 were accurate compared with 518 (80.4%) DRAGON score estimates (P < 0.0001).

Conclusions: ASTRAL, DRAGON and SEDAN scores predict outcome of acute ischaemic stroke patients with higher accuracy compared to physicians interested in stroke.

Keywords: ASTRAL; DRAGON; SEDAN.

MeSH terms

Aged
Aged, 80 and over
Brain Ischemia / diagnosis*
Female
Humans
Intracranial Hemorrhages / diagnosis*
Male
Middle Aged
Physicians
Prognosis
Stroke / diagnosis*