Re-evaluation of the Stroke Prognostication Using Age and NIH Stroke Scale Index (SPAN-100 Index) in IVT Patients - The-SPAN 100 Index

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2018 Aug 31

PMID 30157792

Citations 6

Authors

Cornelia Mobius

Christian Blinzler

Stefan Schwab

Martin Kohrmann

Lorenz Breuer

Affiliations

Soon will be listed here.

Abstract

Background: 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). 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.

Methods: The 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 (SPAN-100 index).

Results: SPAN-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). SPAN-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).

Conclusions: Also 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.

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