Predicting outcome after acute basilar artery occlusion based on admission characteristics
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Abstract
Objective: To develop a simple prognostic model to predict outcome at 1 month after acute basilar artery occlusion (BAO) with readily available predictors.
Methods: The Basilar Artery International Cooperation Study (BASICS) is a prospective, observational, international registry of consecutive patients who presented with an acute symptomatic and radiologically confirmed BAO. We considered predictors available at hospital admission in multivariable logistic regression models to predict poor outcome (modified Rankin Scale [mRS] score 4–5 or death) at 1 month. We used receiver operator characteristic curves to assess the discriminatory performance of the models.
Results: Of the 619 patients, 429 (69%) had a poor outcome at 1 month: 74 (12%) had a mRS score of 4, 115 (19%) had a mRS score of 5, and 240 (39%) had died. The main predictors of poor outcome were older age, absence of hyperlipidemia, presence of prodromal minor stroke, higher NIH Stroke Scale (NIHSS) score, and longer time to treatment. A prognostic model that combined demographic data and stroke risk factors had an area under the receiver operating characteristic curve (AUC) of 0.64. This performance improved by including findings from the neurologic examination (AUC 0.79) and CT imaging (AUC 0.80). A risk chart showed predictions of poor outcome at 1 month varying from 25 to 96%.
Conclusion: Poor outcome after BAO can be reliably predicted by a simple model that includes older age, absence of hyperlipidemia, presence of prodromal minor stroke, higher NIHSS score, and longer time to treatment.
GLOSSARY
- AUC=
- area under the receiver operating characteristic curve;
- BAO=
- basilar artery occlusion;
- BASICS=
- Basilar Artery International Cooperation Study;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale
Footnotes
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Coinvestigators of the BASICS Study Group are listed on the Neurology® Web site at www.neurology.org.
-
Study funding: This study was funded by an unconditional grant from the Brain Foundation of the Netherlands (grant 2010(2).01). The development of the BASICS registry was supported by the Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands.
Supplemental data at www.neurology.org
- Received August 12, 2011.
- Accepted November 17, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
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Letters: Rapid online correspondence
- Respective prediction models for respective treatment managements
- Yingkun He, doctor, Henan Provincial People's Hospital, Zhengzhou University heyingkun@126.com
- Tianxiao Li, china
Submitted April 20, 2012 - Re: Respective prediction models for respective treatment managements
- Wouter J. Schonewille, Department of Neurology, Utrecht Stroke Center, University Medical Center Utrecht, Utrecht, the Nethw.schonewille@antoniusziekenhuis.nl
- Jacoba P. Greving, UMC Utrecht, The Netherlands; L.J. Kappelle, UMC Utrecht, The Netherlands; A. Algra, UMC Utrecht, The Netherlands. ,
Submitted April 20, 2012
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