The Orpington Prognostic Scale: A predictive tool for discharge destination and outcomes in stroke survivors admitted to a hyperacute stroke unit

Abstract

Background/Aims: Accurate assessment of severity of impairment and prediction of prognosis following stroke are important for determining a patient's rehabilitation needs. This study investigates the predictive ability of the Orpington Prognostic Scale, administered within 72 hours of stroke onset, in determining discharge destination and outcomes from a hyperacute stroke unit. Methods: Prospective data were collected from 219 patients with confirmed diagnosis of stroke admitted to a hyperacute stroke unit. Initial Orpington Prognostic Scale scores were compared to discharge destination at 72 hours. The predictive ability of the scale was analysed using logistic regression and multivariate analysis. Results: A low score (<3.2) on the Orpington Prognostic Scale had a high positive predictive value (88.63%) for discharge home, while a high score (>3.2) had a high positive predictive value for further inpatient management (98.39%). The scale showed good predictive ability (odds ratio 27.691, 95% CI 9.852–77.825) for outcome after admission to the hyperacute stroke unit. This was independent of age, gender, type and site of stroke, previous social support and co-morbidity. Conclusions: The Orpington Prognostic Scale could be a valuable tool for predicting discharge destination from a hyperacute stroke unit by early identification of rehabilitation needs 72 hours after stroke following the initial screening. Patients with low scores are highly likely to go home with or without support/therapy, whereas high scorers will require further input in an inpatient setting.