Predicting stroke outcome using clinical- versus imaging-based scoring system

J Stroke Cerebrovasc Dis. 2015 Mar;24(3):642-8. doi: 10.1016/j.jstrokecerebrovasdis.2014.10.009. Epub 2014 Oct 30.


Background: Several models to predict outcome in ischemic stroke patients receiving intravenous (i.v.) alteplase can be divided into clinical-based and imaging-based systems. Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) and Dense cerebral artery sign/early infarct signs on admission CT scan, prestroke modified Rankin Scale (mRS) score, Age, Glucose level at baseline, Onset-to-treatment time, and baseline National Institutes of Health Stroke Scale score (DRAGON) are typical imaging- and clinical-based scoring systems, respectively. Therefore, we compared predictability of stroke outcome of clinical (DRAGON)- and imaging (ASPECTS)-based scoring systems.

Methods: We analyzed patients who were diagnosed with middle cerebral artery territory stroke and treated with i.v. alteplase at Gachon University Gil Hospital over 5 years and compared performance of 2 scoring systems for prediction of good functional outcome (mRS, 0-2) with Pearson correlation and area under the curve-receiver operating characteristic (AUC-ROC). In addition, we analyzed predicting power of several clinical factors and 2 scoring systems by multiple regression analysis.

Results: Study population (N = 120) had mean age of 66.2 ± 13.2 years. ASPECTS (r = -.841, P < .0001) and DRAGON (r = .657, P < .0001) were significantly correlated with good functional outcome. In addition, statistical comparisons suggested that ASPECTS (AUC-ROC, .972; 95% confidence interval [CI], .947-.996) is significantly superior to DRAGON (AUC-ROC, .854; 95% CI, .786-.922) in predicting functional outcome (difference between areas, .118 ± .0332; 95% CI, .0559-.180, P = .0002). Multiple regression analysis revealed that ASPECTS was the independent predictor of good prognosis (OR, 6.59 per 1-point increase; 95% CI, 2.35-18.49; P < .0001 and OR, 77.67 for ASPECTS ≥ 8; 95% CI, 14.30-421.79; P < .0001).

Conclusions: ASPECTS is superior method for predicting functional outcome in acute ischemic stroke patients receiving i.v. alteplase compared with DRAGON and integration of ASPECTS score into clinical care pathway as decision-making tool can be reasonable.

Keywords: ASPECTS score; Cerebral infarct; DRAGON score; outcomes; prognosis; thrombolysis.

Publication types

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

MeSH terms

  • Activities of Daily Living
  • Administration, Intravenous
  • Aged
  • Area Under Curve
  • Cerebral Angiography / methods*
  • Decision Support Techniques*
  • Delivery of Health Care, Integrated
  • Disability Evaluation*
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Hospitals, University
  • Humans
  • Infarction, Middle Cerebral Artery / diagnosis*
  • Infarction, Middle Cerebral Artery / diagnostic imaging
  • Infarction, Middle Cerebral Artery / drug therapy
  • Infarction, Middle Cerebral Artery / physiopathology
  • Male
  • Middle Aged
  • Patient Selection
  • Predictive Value of Tests
  • ROC Curve
  • Recovery of Function
  • Republic of Korea
  • Retrospective Studies
  • Risk Factors
  • Thrombolytic Therapy
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage
  • Tomography, X-Ray Computed*
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator