Abstract
BackgroundThe SPAN-100 index adds patient age and baseline NIHSS-score and was introduced to predict clinical outcome after acute ischemic stroke (AIS). Even with high NIHSS-scores younger patients cannot reach a SPAN-100-positive status (index ≥100). We aimed to evaluate the SPAN-100 index among a large, contemporary cohort of i.v.-thrombolysed AIS-patients and exclusively among older patients who can at least theoretically achieve SPAN-100-positivity.MethodsThe SPAN-100 index was applied to AIS-patients receiving i.v.-thrombolysis (IVT) in our institution between 01/2006 and 01/2013. Clinical outcome and symptomatic intracerebral hemorrhage rates were compared between SPAN-100-positive and -negative patients. Furthermore we excluded patients < 65 years, without any theoretical chance to achieve SPAN-100-positivity, and re-evaluated the index (SPAN65–100 index).ResultsSPAN-100-positive IVT-patients (124/1002) had a 9-fold increased risk for unfavorable outcome compared to SPAN-negative patients (OR 9.39; 95% CI 5.87–15.02; p < 0.001). The odds ratio for mortality was 7.48 (95% CI 4.90–11.43; p < 0.001). No association was found between SPAN-100-positivity and sICH-incidence (OR 0.88; 95% CI 0.31–2.53; p = 0.810).SPAN65–100-positivity (124/741) was associated with an 8-fold increased risk for unfavorable outcome (OR 7.6; 95% CI 4.71–12.22; p < 0.001) but not associated with higher sICH-rates (OR 0.86; 95% CI 0.29–2.53; p < 0.001).ConclusionsAlso for patients ≥65 years the SPAN-100 index can be a fast, easy method to predict clinical outcome of IVT-patients in everyday practice. However, it should not be used to determine the risk of sICH after IVT. Based on a SPAN-positive status IVT should not be withheld from AIS-patients merely because of feared sICH-complications.
Highlights
The SPAN-100 index adds patient age and baseline National Institutes of Health Stroke Scale (NIHSS)-score and was introduced to predict clinical outcome after acute ischemic stroke (AIS)
The index was applied to the dataset of the National Institute of Neurological Disorders and Stroke (NINDS)-Tissue type plasminogen activator (tPA) trials [10] and found to be of good value to predict clinical outcome and risk of intracerebral hemorrhage [9]
Area under the curve (AUC) for the SPAN-100 concerning Modified Rankin Scale (mRS) 4–6 was 0.74; 95%; p < 0.0001; 95% Confidence interval (CI) (0.71–0.77)
Summary
The SPAN-100 index adds patient age and baseline NIHSS-score and was introduced to predict clinical outcome after acute ischemic stroke (AIS). Even with high NIHSS-scores younger patients cannot reach a SPAN-100-positive status (index ≥100). Impact of higher age and higher initial National Institutes of Health Stroke Scale (NIHSS)-scores on clinical outcome after AIS and the way how these two factors interact with each other. The index was applied to the dataset of the National Institute of Neurological Disorders and Stroke (NINDS)-tPA trials [10] and found to be of good value to predict clinical outcome and risk of intracerebral hemorrhage [9]. Even with very high NIHSS-scores they were not able to reach a SPAN-Index of ≥100 Including such patients might have increased selectivity of the score potentially leading to an overestimation of its benefit
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