Systematic Review of Prognostic Models in Patients with Acute StrokeCounsell C. · Dennis M.
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
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Prognostic models in stroke may be useful in clinical practice and research. We systematically reviewed the methodology and results of studies that have identified independent predictors of survival, independence in activities of daily living, and getting home in patients with acute stroke. Eligible studies (published in full in English) included at least 100 patients in whom at least 3 predictor variables were assessed within 30 days of stroke onset and who were followed up for at least 30 days. We recorded 25 indicators of the validity and practicality of each model and identified variables that were consistent independent predictors of each outcome. Eighty-three separate prognostic models were found but most had potentially serious deficiencies in internal and statistical validity, many had limited generalisability, and none had been adequately validated. Only 4 studies met 8 simple quality criteria. Over 150 different predictor variables have been analysed but most were assessed in only 1 or 2 models. None of the existing prognostic models have been sufficiently well developed and validated to be useful in either clinical practice or research. Better quality models must be produced to enable, for example, adequate case-mix correction when comparing outcome among different groups of stroke patients.
© 2001 S. Karger AG, Basel
- Braitman LE, Davidoff F: Predicting clinical states in individual patients. Ann Intern Med 1996;125:406–412.
- Harrell FE, Lee KL, Mark DB: Multivariate prognostic models: Issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996;15:361–387.
- Kwakkel G, Wagenaar RC, Kollen BJ, Lankhorst GJ: Predicting disability in stroke – a critical review of the literature. Age Ageing 1996;25:479–489.
- Berlowitz DR, Ash AS, Brandeis GH, Brand HK, Halpern JL, Moskowitz MA: Rating long-term care facilities on pressure ulcer development: Importance of case-mix adjustment. Ann Intern Med 1996;124:557–563.
- Chassin MR, Hannan EL, DeBono BA: Benefits and hazards of reporting medical outcomes publicly. N Engl J Med 1996;334:394–398.
- Altman DG: Comparability of randomised groups. Statistician 1985;34:125–136.
- Rothwell PM: Can overall results of clinical trials be applied to all patients? Lancet 1995;345:1616–1619.
- Sharp SJ, Thompson SG, Altman DG: The relation between treatment benefit and underlying risk in meta-analysis. BMJ 1996;313:735–738.
- Hier DB, Edelstein G: Deriving clinical prediction rules from stroke outcome research. Stroke 1991;22:1431–1436.
- Jongbloed L: Prediction of function after stroke: A critical review. Stroke 1986;17:765–776.
- Segal ME, Whyte J: Modeling case mix adjustment of stroke rehabilitation outcomes. Am J Phys Med Rehabil 1997;76:154–161.
van Gijn J: Measurement of outcome in stroke prevention trials. Cerebrovasc Dis 1992;2 (suppl 1):23–34.
Jongbloed L: Problems of methodological heterogeneity in studies predicting disability after stroke. Stroke 1990;21:II-32–II-34.
- Peduzzi P, Concato J, Feinstein AR, Holford TR: Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates. J Clin Epidemiol 1995;48:1503–1510.
- Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR: A stimulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49:1373–1379.
- Bamford J, Sandercock P, Dennis M, Burn J, Warlow C: A prospective study of acute cerebrovascular disease in the community: The Oxfordshire Community Stroke Project –1981–86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 1990;53:16–22.
- Counsell C: Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med 1997;127:380–387.
- Wasson JH, Sox HC, Neff RK, Goldman L: Clinical prediction rules. Applications and methodological standards. N Engl J Med 1985;313:793–799.
Wyatt JC, Altman DG: Commentary: Prognostic models: Clinically useful or quickly forgotten? BMJ 1995;311:1539–1541.
- Anderson C: Baseline measures and outcome predictions. Neuroepidemiology 1994;13:283–289.
- Kernan WN, Feinstein AR, Brass L: A methodological appraisal of research on prognosis after transient ischemic attacks. Stroke 1991;22:1108–1116.
- Laupacis A, Sekar N, Stiell IG: Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA 1997;277:488–494.
Altman DG: Relation between several variables; in Practical Statistics for Medical Research. London, Chapman & Hall, 1993, pp 325–364.
- Anderson CS, Jamrozik KD, Stewart-Wynne EG: Predicting survival after stroke: Experience from the Perth Community Stroke Study. Clin Exp Neurol 1992;29:117–128.
- Anderson CS, Jamrozik KD, Broadhurst RJ, Stewart-Wynne EG: Predicting survival for 1 year among different subtypes of stroke. Results from the Perth Community Stroke Study. Stroke 1994;25:1935–1944.
- Bonita R, Ford MA, Stewart AW: Predicting survival after stroke: A three-year follow-up. Stroke 1988;19:669–673.
- Kelly-Hayes M, Wolf PA, Kannel WB, Sytkowski P, D’Agostino RB, Gresham GE: Factors influencing survival and need for institutionalization following stroke: The Framingham Study. Arch Phys Med Rehabil 1988;69:415–418.
- Anderson CS, Taylor BV, Hankey GJ, Stewart-Wynne EG, Jamrozik KD: Validation of a clinical classification for subtypes of acute cerebral infarction. J Neurol Neurosurg Psychiatry 1994;57:1173–1179.
- Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, D’Agostino RB: Stroke severity in atrial fibrillation. The Framingham Study. Stroke 1996;27:1760–1764.
Ryglewicz D, Hier DB, Weissbein T, Baranska-Gieruszczak M, Czlonkowska A: Factors predicting 30-day mortality in the Warsaw stroke registry. J Stroke Cerebrovasc Dis 1995;5:72–77.
- Allen CM: Predicting the outcome of acute stroke: A prognostic score. J Neurol Neurosurg Psychiatry 1984;47:475–480.
Allen CM: Predicting outcome after acute stroke: Role of computerised tomography [letter]. Lancet 1984;2:464–465.
Anderson CS, Jamrozik KD, Stewart-Wynne EG: Patterns of acute hospital care, rehabilitation, and discharge disposition after acute stroke: the Perth Community Stroke Study 1989–1990. Cerebrovasc Dis 1994;4:344–353.
Asplund K, Carlberg B, Sundstrom G: Stroke in the elderly. Observations in a population-based sample of hospitalized patients. Cerebrovasc Dis 1992;2:152–157.
- Azzimondi G, Bassein L, Nonino F, Fiorani L, Vignatelli L, Re G, D’Alessandro R: Fever in acute stroke worsens prognosis. A prospective study. Stroke 1995;26:2040–2043.
- Barer DH, Mitchell JR: Predicting the outcome of acute stroke: Do multivariate models help? Q J Med 1989:70:27–39.
- Czlonkowska A, Ryglewicz D, Lechowicz W: Basic analytical parameters as the predictive factors for 30-day case fatality rate in stroke. Acta Neurol Scand 1997;95:121–124.
- Daley J, Jencks S, Draper D, Lenhart G, Thomas N, Walker J: Predicting hospital-associated mortality for Medicare patients. A method for patients with stroke, pneumonia, acute myocardial infarction, and congestive heart failure. JAMA 1988;260:3617–3624.
- Davalos A, Ricart W, Gonzalez-Huix F, Soler S, Marrugat J, Molins A, Suner R, Genis D: Effect of malnutrition after acute stroke on clinical outcome. Stroke 1996;27:1028–1032.
- Dyker AG, Weir CJ, Lees KR: Influence of cholesterol on survival after stroke: Retrospective study. BMJ 1997;314:1584–1588.
- Friedman PJ: Serum creatinine: An independent predictor of survival after stroke. J Intern Med 1991;229:175–179.
- Fullerton KJ, Mackenzie G, Stout RW: Prognostic indices in stroke. Q J Med 1988;66:147–162.
- Gray CS, French JM, Bates D, Cartlidge NE, Venables GS, James OF: Increasing age, diabetes mellitus and recovery from stroke. Postgrad Med J 1989;65:720–724.
- Jorgensen H, Nakayama H, Raaschou HO, Olsen TS: Stroke in patients with diabetes. The Copenhagen Stroke Study. Stroke 1994;25:1977–1984.
Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS: Intracerebral hemorrhage versus infarction: Stroke severity, risk factors, and prognosis. Arch Neurol 1995;38:45–50.
- Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS: Acute stroke with atrial fibrillation. The Copenhagen Stroke Study. Stroke 1996;27:1765–1769.
- Reith J, Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS: Seizures in acute stroke: Predictors and prognostic significance. The Copenhagen Stroke Study. Stroke 1997;28:1585–1589.
- M’Buyamba-Kabangu JR, Longo-Mbenza B, Tambwe MJ, Dikassa LN, Mbala-Mukendi M: J-shaped relationship between mortality and admission blood pressure in black patients with acute stroke. J Hypertens 1995;13:1863–1868.
- Morris PL, Robinson RG, Andrzejewski P, Samuels J, Price TR: Association of depression with 10-year poststroke mortality. Am J Psychiatry 1993;150:124–129.
- Muir KW, Weir CJ, Murray GD, Povey C, Lees KR: Comparison of neurological scales and scoring systems for acute stroke prognosis. Stroke 1996;27:1817–1820.
- Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS: The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke 1994;25:808–813.
- Prescott RJ, Garraway WM, Akhtar AJ: Predicting functional outcome following acute stroke using a standard clinical examination. Stroke 1982;13:641–647.
- Reith J, Jorgensen HS, Pedersen PM, Nakayama H, Raaschou HO, Jeppesen LL, Olsen TS: Body temperature in acute stroke: Relation to stroke severity, infarct size, mortality, and outcome. Lancet 1996;347:422–425.
Robinson T, Waddington A, Ward-Close S, Taub N, Potter J: The predictive role of 24-hour compared to casual blood pressure levels on outcome following stroke. Cerebrovasc Dis 1997;7:264–272.
- Rodrigues CJ, Joshi VR: Predicting the immediate outcome of patients with cerebrovascular accident: A prognostic score. J Assoc Physicians India 1991;39:175–180.
- Sheikh K, Brennan PJ, Meade TW, Smith DS, Goldenberg E: Predictors of mortality and disability in stroke. J Epidemiol Community Health 1983;37:70–74.
- Smithard DG, O’Neill PA, Parks C, Morris J: Complications and outcome after acute stroke. Does dysphagia matter? Stroke 1996;27:1200–1204.
- Sprafka JM, Virnig BA, Shahar E, McGovern PG: Trends in diabetes prevalence among stroke patients and the effect of diabetes on stroke survival: The Minnesota Heart Survey. Diabet Med 1994;11:678–684.
- Viitanen M, Eriksson S, Asplund K, Wester PO, Winblad B: Determinants of long-term mortality after stroke. Acta Med Scand 1987;221:349–356.
- Weir CJ, Murray GD, Dyker AG, Lees KR: Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow-up. BMJ 1997;314:1303–1306.
- Westling B, Norrving B, Thorngren M: Survival following stroke: A prospective population-based study of 438 hospitalized cases with prediction according to subtype, severity and age. Acta Neurol Scand 1990;81:457–463.
- Andre C, Novis SA: Clinical factors adversely affecting early outcome after brain infarction. Arq Neuropsiquiatr 1994;52:153–160.
- Candelise L, Pinardi G, Morabito A: Mortality in acute stroke with atrial fibrillation. The Italian Acute Stroke Study Group. Stroke 1991;22:169–174.
- Carlberg B, Asplund K, Hagg E: The prognostic value of admission blood pressure in patients with acute stroke. Stroke 1993:24:1372–1375.
- Censori B, Camerlingo M, Casto L, Ferraro B, Gazzaniga GC, Cesana B, Mamoli A: Prognostic factors in first-ever stroke in the carotid artery territory seen within 6 hours after onset. Stroke 1993;24:532–535.
- Chambers BR, Norris JW, Shurvell BL, Hachinski VC: Prognosis of acute stroke. Neurology 1987;37:221–225.
- Clavier I, Hommel M, Besson G, Noelle B, Perret JE: Long-term prognosis of symptomatic lacunar infarcts. A hospital-based study. Stroke 1994;25:2005–2009.
- Finocchi C, Gandolfo C, Gasparetto B, Del Sette M, Croce R, Loeb C: Value of early variables as predictors of short-term outcome in patients with acute focal cerebral ischemia. Ital J Neurol Sci 1996;17:341–346.
- Fiorelli M, Alperovitch A, Argentino C, Sacchetti ML, Toni D, Sette G, Cavalletti C, Gori MC, Fieschi C: Prediction of long-term outcome in the early hours following acute ischemic stroke. Italian Acute Stroke Group. Arch Neurol 1995;52:250–255.
- Friedman P: Predictors of survival after cerebral infarction: Importance of cardiac factors. Aust N Z J Med 1994:24:51–54.
- Frithz G, Werner I: Studies on cerebrovascular strokes. II. Clinical findings and short-term prognosis in a stroke material. Acta Med Scand 1976;199:133–140.
- Henon H, Godefroy O, Leys D, Mounier-Vehier F, Lucas C, Rondepierre P, Duhamel A, Pruvo JP: Early predictors of death and disability after acute cerebral ischemic event. Stroke 1995;26:392–398.
- Howard G, Walker MD, Becker C, Coull B, Feibel J, McLeroy K, Toole JF, Yatsu F: Community hospital-based stroke programs: North Carolina, Oregon, and New York. Factors influencing survival after stroke: Proportional hazards analysis of 4,219 patients. Stroke 1986;17:294–299.
- Matchar DB, Divine GW, Heyman A, Feussner JR: The influence of hyperglycemia on outcome of cerebral infarction. Ann Intern Med 1992;117:449–456.
- Sacco RL, Shi T, Zamanillo MC, Kargman DE: Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology 1994;44:626–634.
- Salgado AV, Ferro JM, Gouveia-Oliveira A: Long-term prognosis of first-ever lacunar strokes. A hospital-based study. Stroke 1996;27:661–666.
- Toni D, Fiorelli M, Bastianello S, Sacchetti ML, Sette G, Argentino C, Montinaro E, Bozzao L: Hemorrhagic transformation of brain infarct: Predictability in the first 5 hours from stroke onset and influence on clinical outcome. Neurology 1996;46:341–345.
- Toni D, Fiorelli M, Bastianello S, Falcou A, Sette G, Ceschin V, Sacchetti ML, Argentino C: Acute ischemic strokes improving during the first 48 hours of onset: Predictability, outcome, and possible mechanisms. A comparison with early deteriorating strokes. Stroke 1997;28:10–14.
- Weir CJ, Bolster AA, Tytler S, Murray GD, Corrigall RS, Adams FG, Lees KR: Prognostic value of single-photon emission tomography in acute ischaemic stroke. Eur J Nucl Med 1997;24:21–26.
Beldman TFJ, Rinkel GJE, Algra A: Prediction of long-term outcome after primary intracerebral haemorrhage: The importance of the site of the lesion. Cerebrovasc Dis 1997;7:85–88.
- Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G: Volume of intracerebral hemorrhage: A powerful and easy-to-use predictor of 30-day mortality. Stroke 1993;24:987–993.
- Daverat P, Castel JP, Dartigues JF, Orgogozo JM: Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis. Stroke 1991;22:1–6.
- Dixon AA, Holness RO, Howes WJ, Garner JB: Spontaneous intracerebral haemorrhage: An analysis of factors affecting prognosis. Can J Neurol Sci 1985;12:267–271.
- Franke CL, van Swieten JC, Algra A, van Gijn J: Prognostic factors in patients with intracerebral haematoma. J Neurol Neurosurg Psychiatry 1992;55:653–657.
- Juvela S: Risk factors for impaired outcome after spontaneous intracerebral hemorrhage. Arch Neurol 1995;52:1193–1200.
- Lampl Y, Gilad R, Eshel Y, Sarova-Pinhas I: Neurological and functional outcome in patients with supratentorial hemorrhages. A prospective study. Stroke 1995;26:2249–2253.
- Mase G, Zorzon M, Biasutti E, Tasca G, Vitrani B, Cazzato G: Immediate prognosis of primary intracerebral hemorrhage using an easy model for the prediction of survival. Acta Neurol Scand 1995;91:306–309.
- Mori S, Sadoshima S, Ibayashi S, Fujishima M, Iino K: Impact of thalamic hematoma on six-month mortality and motor and cognitive functional outcome. Stroke 1995;26:620–626.
- Portenoy RK, Lipton RB, Berger AR, Lesser ML, Lantos G: Intracerebral haemorrhage: A model for the prediction of outcome. J Neurol Neurosurg Psychiatry 1987;50:976–979.
- Tuhrim S, Dambrosia JM, Price TR, Mohr JP, Wolf PA, Heyman A, Kase CS: Prediction of intracerebral hemorrhage survival. Ann Neurol 1988;24:258–263.
- Tuhrim S, Dambrosia JM, Price TR, Mohr JP, Wolf PA, Hier DB, Kase CS: Intracerebral hemorrhage: External validation and extension of a model for prediction of 30-day survival. Ann Neurol 1991;29:658–663.
- Granger CV, Hamilton BB, Gresham GE, Kramer AA: The stroke rehabilitation outcome study. II. Relative merits of the total Barthel index score and a four-item subscore in predicting patient outcomes. Arch Phys Med Rehabil 1989;70:100–103.
- Lincoln NB, Blackburn M, Ellis S, Jackson J, Edmans JA, Nouri FM, Walker MF, Haworth H: An investigation of factors affecting progress of patients on a stroke unit. J Neurol Neurosurg Psychiatry 1989;52:493–496.
- Wade DT, Skilbeck CE, Wood VA, Longton Hewer R: Long-term survival after stroke. Age Ageing 1984;13:76–82.
- Gladman JR, Harwood DM, Barer DH: Predicting the outcome of acute stroke: Prospective evaluation of five multivariate models and comparison with simple methods. J Neurol Neurosurg Psychiatry 1992:55:347–351.
- Tuhrim S, Horowitz DR, Sacher M, Godbold JH: Validation and comparison of models predicting survival following intracerebral hemorrhage. Crit Care Med 1995;23:950–954.
- Chua MG, Davis SM, Infeld B, Rossiter SC, Tress BM, Hopper JL: Prediction of functional outcome and tissue loss in acute cortical infarction. Arch Neurol 1995;52:496–500.
Burn J, Sandercock P: Predicting the outcome after acute stroke. J Neurol Neurosurg Psychiatry 1993;56:576.
- Gompertz P, Pound P, Ebrahim S: Predicting stroke outcome: Guy’s prognostic score in practice. J Neurol Neurosurg Psychiatry 1994;57:932–935.
- Lincoln NB, Jackson JM, Edmans JA, Walker MF, Farrow VM, Latham A, Coombes K: The accuracy of predictions about progress of patients on a stroke unit. J Neurol Neurosurg Psychiatry 1990:53:972–975.
- Metz CE: Basic principles of ROC analysis. Semin Nucl Med 1978;8:283–298.
- Moher D, Fortin P, Jadad AR, Juni P, Klassen T, Le Lorier J, Liberati A, Linde K, Penna A: Completeness of reporting of trials in languages other than English: Implications for conduct and reporting of systematic reviews. Lancet 1996;347:363–366.
- Dickersin K, Min Y-I: Publication bias: The problem that won’t go away. Ann NY Acad Sci 1994;703:135–148.
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