Kate Rowland, MD, MS
Does a clinical prediction rule based on data collected at hospital admission predict risk for death and severe disability after acute ischemic stroke?
Registry-based cohort study with individual patient linkage to administrative databases and separate derivation and validation cohorts.
11 regional stroke centers in Ontario, Canada.
9847 patients ≥ 18 years of age (mean age 73 y, 52% men) who were hospitalized with acute ischemic stroke and included in the Registry of the Canadian Stroke Network. Exclusion criteria were transient ischemic attack, intracerebral or subarachnoid hemorrhage, or use of thrombolytic therapy. The derivation cohort comprised 4943 patients admitted between July 2003 and November 2005, and the validation cohort comprised 4904 patients admitted between December 2005 and March 2008.
The PLAN score included 9 variables: Preadmission comorbid conditions (dependence and cancer [1.5 points each] and congestive heart failure and atrial fibrillation [1 point each]), Level of consciousness (5 points for reduced level), Age (1 point/decade, maximum 10 points), and Neurologic focal deficits (significant or total leg weakness [2 points], significant or total arm weakness [2 points], and aphasia or neglect [1 point]). Maximum score is 25.
30-day and 1-year mortality, and death or severe disability (modified Rankin Score 5 or 6) at discharge.
Outcomes by PLAN score are reported in the Table. The c-statistics for the derivation and validation cohorts were similar for all outcomes (30-d mortality, 0.85 vs 0.87; 1-y mortality, 0.82 vs 0.84; and death or severe disability at discharge, 0.89 vs 0.88). Correlation between observed and expected outcomes was 0.99 (Pearson coefficient) for all outcomes.
The 9-item PLAN score based on data collected at hospital admission predicted death and severe disability in patients with acute ischemic stroke.
PLAN score for predicting death and severe disability in patients hospitalized with acute ischemic stroke*
*PLAN = Preadmission comorbid conditions, Level of consciousness, Age, and Neurologic focal deficits. Includes data from the combined derivation and validation cohorts.
†Modified Rankin Score of 5 or 6.
Kate Rowland. The PLAN score predicted death and severe disability in patients with acute ischemic stroke. Ann Intern Med. 2013;158:JC13. doi: 10.7326/0003-4819-158-4-201302190-02013
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Published: Ann Intern Med. 2013;158(4):JC13.
Hospital Medicine, Neurology, Stroke.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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