5/18/2016 ISCORESORCan

Name: Date:18May2016

ISCORE CNS GCS

IschemicStrokePredictiveRiskScore
Calculator Outcomes:Mortality FunctionalOutcomesatDischarge

30DayMortality 30DayDeathorDisability

Checkifyouneedhelptoestimatestroke ISCORE ISCORE

severity(CNS) Mortality % DeathorDisability %

ManualCNS/NHISSentry

CNS NIHSS

ISCORE
Age years
Sex Male Female
StrokeSeverity CNS
StrokeSubtype Lacunar

RiskFactors
Atrialfibrillation 1YearMortality 30DayDeathorInstitutionalization
CHF ISCORE ISCORE
Previousmyocardialinfarction Mortality % DeathorInstitutionalization %
Currentsmoker

ComorbidConditions
Cancer
Renaldiseaseondialysis

PreadmissionDisability
Dependent

GlucoseonAdmission
7.5mmol/L(>135mg%)
Deathwascapturedupto30dayspostdischarge

ThrombolyticTherapy
ProbabilityofGoodClinicalOutcome(mRS02) ComplicationsofIntracranialHemorrhage

tPAtherapy

Information
ClickheretodownloadtheoriginalpaperfortheIScore
Theearlyuseofprognosticdatausingsimpleelementsmayhelpcliniciansinmakingtreatmentdecisions
andinprovidingreliableinformationwhencounselingpatientsandtheirfamilies.

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5/18/2016 ISCORESORCan
TheIScore(IschemicStrokePredictiveRiskScore)isavalidatedtoolthatmayassistclinicianstoestimate
the risk of death (at 30day and at 1year), disability (as defined by the modified Rankin scale >=3) and
institutionalization, during the initial assessment in the Emergency department or early after hospital
admissionforpatientswithanacuteischemicstroke.
It consist in clinical parameters and chronic comorbid conditions: including age, sex, stroke severity and
subtype, history of atrial fibrillation, coronary artery disease, cardiac cancer, kidney disease on dialysis,
smoking,hyperglycemiaonadmission,anddependencypriortothestroke,allassociatedwith30dayand1
year mortality.The score was validated in an internal and external cohorts including over 16,000 patients
withanacuteischemicstroke.
IScoreallowstheinputofstrokeseverityeitherusingtheCNSscale(asvalidated)ortheNIHSS(commonly
usedintheinitialassessmentbystrokeneurologists).Patientswithdecreasedlevelofconsciousness,i.e.
coma,shouldbegivenaCNS=0orNIHSS>=23.
Thescoreassignedtoeachvariableisshownintherightuppercornerofthiswebsite.Justsimpleselectthe
characteristicsofyourpatientandyouwillhavetheestimatedriskofdeathdisplayedrightaway.
ViewtheNIHStrokeScale.
ThrombolyticTherapy
Thrombolysisisthemostacceptedeffectiveandproventreatmentforanacuteischemicstroke.Thedecision
ofgivingintravenousthrombolysis(tPA)maybechallenging,especiallyinpatientswithhigherprevalence
comorbid conditions, preadmission dependency, and dementia. Patients and families wonder about the
likelihood of a good outcome, especially if the risk of developing hemorrhagic complications is high.
Unfortunately,therearenotoolsthatassistclinicianspredicttheresponsetotPA.
Werecentlydevelopedandvalidatedariskscore(iScore)thatcanbeusedtoestimatetheriskofdeathand
disabilityafteranacuteischemicstroke(Saposniketal.Circulation2011andStroke2011).TheiScorewas
designedtoallowforbroaderutilityatacademiccentersorsmallcommunityhospitalswithlimitedresources.
Itincludesclinicalvariableseasilyobtainedintheearlyhoursofhospitalpresentation.
In the present study, we applied the iScore (www.sorcan.ca/iscore) to over 12,000 patients with an acute
ischemic stroke admitted to 11 stroke centers in Ontario. A cohort of patients with stroke treated at 154
generalhospitalsinOntariowasusedtodeterminetheconsistencyofourresults.
AmongpatientswithalowandmediumiScore,tPAusewasassociatedwithreductionindeathanddisability.
However, there was no such benefit in patients with a higher iScore. Moreover, the risk of neurological
deteriorationandintracerebralhemorrhagewassignificantlyhigherinthishighriskgroup.
Patients with a high iScores may not have a clinically meaningful benefit from tPA (NNT 385 NS) while
carryingasignificantlyhigherriskofhemorrhagiccomplications(NNH517p<0.05)
Resultswereconsistentinthevalidationcohort,aswellas,whenapplyingtheiScoretodataderivedfromthe
NINDStPArandomizedclinicaltrial(manuscriptinpreparation).
Therisk,benefits,andqualityoflifeaftertPAinselectedhighriskgroupshasbeenunderdebate.Ourstudy
suggests that the iScore can be used to estimate the clinical response and risk of complications after
thrombolytic therapy for ischemic stroke. These results may facilitate information to clinicians when
discussingtherapeuticoptionsandprognosiswithpatientsandtheirfamilies.
Definitions
NNH:numberneededtoharm
mRS02:modifiedrankingscale02forafavorableoutcome

References

SaposnikG,FangJ,KapralM,TuJ,MamdaniM,AustinP,JohnstonS,onbehalfofthe
InvestigatorsoftheRegistryoftheCanadianStrokeNetwork(RCSN)andtheStrokeOutcomes
ResearchCanada(SORCan)WorkingGroup.TheiScorepredictseffectivenessofthrombolytic
therapyforacuteischemicstroke.StrokeFebruary2012.

SaposnikG,KapralMK,LiuY,O'DonnellM,RaptisR,TuJ,MamdaniM,AustinPC,onbehalfofthe
InvestigatorsoftheRegistryoftheCanadianStrokeNetworkandtheStrokeOutcomeResearch
Canada(SORCan)Group.IScore:ARiskScoretoPredictDeathearlyafterHospitalizationforan
AcuteIschemicStroke.CirculationFebruary2011.

SaposnikG,RaptisR,KapralMK,LiuY,TuJV,MamdaniM,AustinPA,onbehalfofthe
InvestigatorsoftheRegistryoftheCanadianStrokeNetworkandtheStrokeOutcomeResearch
Canada(SORCan)WorkingGroup.TheIScorePredictsPoorFunctionalOutcomesEarlyAfter
HospitalizationforanAcuteIschemicStroke.StrokeDecember2011.

NilanontY,KomoltriC,SaposnikG,etal.TheCanadianNeurologicalScaleandtheNIHSS:
developmentandvalidationofasimpleconversionmodel.CerebrovascDis.201030(2):1206.

TheCanadianNeurologicalScale:validationandreliabilityassessment.CtR,BattistaRN,
WolfsonC,BoucherJ,AdamJ,HachinskiV.Neurology.1989May39(5):63843.

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Author
Dr.GustavoSaposnik

Developers
Dr.ChiMingChow
EdwardBrawer

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