Functional outcome (modified Rankin scale (mRS)), and quality of life (visual analogue scale (VAS)) at six months in major disabling stroke who had a Barthel Index ≤6 (of 20) at day four. Unfavorable functional outcome was defined as mRS >3, non-satisfactory quality of life as VAS <60. Followed-up at six months after stroke.
60 were included, with a mean age of 72 years. Of 15 who were predicted to worsen, one actually survived at six months (positive predictive value (PPV), 0.93; 95% CI, 0.66–0.99). Of thirty who survived, one was predicted to end (false positive rate (FPR), 0.03; 95%CI 0.00–0.20). Of forty-six who were predicted to have an unfavorable outcome, four had a favorable outcome (PPV, 0.93; 95% CI, 0.81–0.98; FPR, 0.30; 95% CI; 0.08–0.65). Prediction of non-satisfactory quality of life was less accurate (PPV, 0.63; 95% CI, 0.26–0.90; FPR, 0.18; 95% CI 0.05–0.44).
Included in the Advance Directive And Proxy opinions in acute sTroke (ADAPT) cohort, a prospective, two-center cohort study. Consecutive admits at the stroke unit with major disability, defined as Barthel Index (BI) ≤6 (out of 20) at day four after ischemic stroke or intracerebral hemorrhage were eligible for participation. This population is the only one under evaluation because these are the only ones in whom treatment restrictions are most often considered.
The frequently used iScore for ischemic stroke and ICH score for intracerebral hemorrhage have areas under the curve for prognosis end case at 30 days of 0.79 and 0.88, respectively, in validation studies. This means that both prognostic models and prognostic estimates lack the accuracy to serve as sole base for decisions. The predictive accuracy might increase when using a combination of ‘mathematical’ prediction models and prognostic estimates.
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