External validation of the DRAGON score in an elderly Spanish population: prediction of stroke prognosis after IV thrombolysis

Cerebrovasc Dis. 2013;36(2):110-4. doi: 10.1159/000352061. Epub 2013 Sep 11.


Background: Intravenous (i.v.) thrombolysis within 4.5 h of symptom onset has proven efficacy in acute ischemic stroke treatment, although half of all outcomes are unfavorable. The recently published DRAGON score aims to predict the 3-month outcome in stroke patients who have received i.v. alteplase. The purpose of this study was an external validation of the results of the DRAGON score in a Spanish cohort.

Methods: Patients with acute stroke treated with alteplase were prospectively registered in our BasicMar database. We collected demographic characteristics, vascular risk factors, the time from stroke onset to treatment, baseline serum glucose levels and stroke severity for this population. We then reviewed hyperdense cerebral artery signs and signs of early infarct on the admission CT scan. We calculated the DRAGON score and used the developers' 3-month prognosis categories: good [modified Rankin Scale score (mRS) 0-2], poor (mRS 3-6) and miserable (mRS 5-6) outcome. Discrimination was tested using the area under the receiver operator curve (AUC-ROC). Calibration was assessed by the Hosmer-Lemeshow test.

Results: Our final cohort of 297 patients was older (median age 74 years, IQR 65-80) and had more risk factors and severe strokes [median National Institutes of Health Stroke Scale (NIHSS) points 13, IQR 7-19] than the original study population. Poor prognosis was observed in 143 (48.1%) patients. Higher DRAGON scores were associated with a higher risk of poor prognosis. None of our treated stroke patients with a DRAGON score ≥8 at admission experienced a favorable outcome after 3 months. All DRAGON variables were significantly associated with a worse outcome in the multivariate analysis except for onset-to-treatment time (p = 0.334). Discrimination to predict poor prognosis was very good (AUC-ROC 0.84) and the score had good Hosmer-Lemeshow calibration (p = 0.84).

Conclusions: The DRAGON score is easy to perform and offers a rapid, reliable prediction of poor prognosis in acute-stroke patients treated with alteplase. This study replicates the original results in a different population.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / drug therapy
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Risk Factors
  • Severity of Illness Index
  • Stroke / diagnosis
  • Stroke / drug therapy*
  • Thrombolytic Therapy / methods
  • Tissue Plasminogen Activator / therapeutic use


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator