Long-Term Prediction of Functional Outcome After Stroke Using the Alberta Stroke Program Early Computed Tomography Score in the Subacute Stage

doi:10.1016/j.jstrokecerebrovasdis.2011.03.010

Journal of Stroke and Cerebrovascular Diseases

Volume 21, Issue 8, November 2012, Pages 737-744

https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.03.010 Get rights and content

Stroke patients who arrive at hospital more than 24 hours after symptom onset could benefit from a simple means of assessing long-term prognosis in this subacute stage. We evaluated whether clinical factors along with ischemic injury assessed subacutely using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) had predictive value for functional independence after stroke. Computed tomography (CT) scans obtained ≥2 days after first-ever ischemic stroke were scored independently and retrospectively by 3 stroke neurologists using the ASPECTS. Functional outcome was measured using the Functional Independence Measure, which assesses the amount of caregiver assistance required by patients during daily activities. Multiple linear regression was used to develop a predictive model for functional prognosis at 1 month, 3 months, and 1 year poststroke. For our 55 patients, CT scanning was done on average 4 days poststroke. The interrater agreement for subacute ASPECTS was excellent, with a κ-weighted value of 0.90. Lesions involving the frontal and superior parietal ASPECTS regions were significant predictors of lower Functional Independence Measure scores at all 3 time points studied. In combination with such factors as age, marital status, and the severity of initial neurologic deficit, a subacute ASPECTS score >5 had significant predictive value for greater functional independence at 3 months (R² = 0.701; P < .001) and 1 year (R² = 0.528; P < .001) poststroke. Our data indicate that in the subacute stage, ASPECTS is reliable and can help predict which patients may be likely to regain functional independence up to 1 year after sustaining ischemic stroke.

Section snippets

Study Population

All patients with subacute (≥2 days postictus, up to 30 days poststroke), unilateral, first-ever ischemic stroke and with a CT scan and FIM data available in the Sunnybrook Stroke Study research database were analyzed for this study. Details of the Sunnybrook Stroke Study research database are available elsewhere.14, 15 Because these data were collected in a prethrombolysis era (1990-1993), no patients included in this study received thrombolytic treatment, providing a unique opportunity for a

Results

A total of 160 patients were initially screened and assessed using the FIM. From this group, 55 patients (28 males, 27 females; mean age, 71.6 years; 32 with right hemisphere stroke) met our inclusion criteria. These patients’ demographic and clinical characteristics are summarized in Table 1. The most frequent reasons for patients not meeting our inclusion criteria were premorbid FIM score <100, hemorrhagic stroke, and CT scans obtained outside of our time frame. Most CT scans were obtained

Discussion

Ischemic changes that can be visualized by neuroimaging studies within the first days after stroke are thought to result from a complex series of pathophysiological events, including excitotoxicity, edema, inflammation, and cell apoptosis.²⁶ Previous studies that examined the value of these visualizable ischemic changes for predicting functional outcome used potentially time-consuming computerized lesion quantification methods and did not obtain brain images using CT, the most commonly used

Acknowledgment

We thank Joanne Lawrence for her assistance with data collection.

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: Supported by funding from the Heart and Stroke Foundation Centre for Stroke Recovery, Heart and Stroke Foundation of Ontario, and Canadian Institutes of Health Research. J.P. received fellowship funding from Canadian Institutes of Health Research and the Alberta Heritage Foundation of Medical Research. D.S. receives funding from the M.G. DeGroote Professorship in Stroke Management. S.B. receives support from the Sunnybrook Research Institute and the Department of Medicine at Sunnybrook Health Sciences Centre, University of Toronto. None of the funding sources were involved in data collection, analysis, or interpretation or in the writing or submission of this manuscript. The authors declare no conflicts of interest.

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Original ArticleLong-Term Prediction of Functional Outcome After Stroke Using the Alberta Stroke Program Early Computed Tomography Score in the Subacute Stage

Section snippets

Study Population

Results

Discussion

Acknowledgment

Arch Phys Med Rehabil

Lancet

Lancet

J Stroke Cerebrovasc Dis

Arch Phys Med Rehabil

Trends Neurosci

Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke

AJNR Am J Neuroradiol

Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion

Stroke

Alberta Stroke Program Early CT Scoring of CT perfusion in early stroke visualization and assessment

AJNR Am J Neuroradiol

Utilization of intravenous tissue plasminogen activator for acute ischemic stroke

Arch Neurol

Time to hospital arrival, use of thrombolytics, and in-hospital outcomes in ischemic stroke

Neurology

Selection of acute ischemic stroke patients for intra-arterial thrombolysis with pro-urokinase by using ASPECTS

Stroke

Computed tomographic findings in patients undergoing intra-arterial thrombolysis for acute ischemic stroke due to middle cerebral artery occlusion: Results from the PROACT II trial

Stroke

Predicting spontaneous early neurological recovery after acute ischemic stroke

Eur J Neurol

Combined clinical and imaging information as an early stroke outcome measure

Stroke

Original Article
Long-Term Prediction of Functional Outcome After Stroke Using the Alberta Stroke Program Early Computed Tomography Score in the Subacute Stage