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TURN Score Predicts 90-day Outcome in Acute Ischemic Stroke Patients After IV Thrombolysis

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Abstract

Background and Purpose

We developed the TURN score for predicting symptomatic intracerebral hemorrhage (sICH) after IV thrombolysis. Our purpose was to evaluate its ability to predict 90-day outcome.

Methods

We retrospectively analyzed data from 303 patients who received IV rt-PA during the NINDS rt-PA trial. Severe outcome was defined as 90-day modified Rankin scale (mRS) scores ≥5, 90-day Barthel index (BI) scores <60 and 90-day Glasgow Outcome Scale (GOS) scores >2. Excellent outcome was defined as 90-day mRS scores ≤1, 90-day BI scores ≥95 and 90-day GOS scores = 1. Agreement between TURN and 90-day outcome was assessed by univariate logistic regression reporting odds ratios (OR) and by areas under the receiver operating characteristic curves (AUROC). TURN was also compared with 6 other scores for predicting sICH or severe outcome.

Results

TURN predicted 90-day mRS ≥5 with OR 5.73, 95 % confidence interval (3.60, 9.10), P < 0.001 and AUROC 0.83, 95 % confidence interval (0.77, 0.89). TURN also predicted 90-day mRS ≤1 with OR 5.24, 95 % confidence interval (3.43, 7.99), P < 0.001 and AUROC 0.80, 95 % confidence interval (0.74, 0.85). TURN predicted 90-day mRS ≥5 with OR significantly higher than DRAGON (2.30, P = 0.01), ASTRAL (1.18, P < 0.001), HAT (2.89, P = 0.05) and SEDAN (2.16, P = 0.01), and with AUROC significantly higher than SPAN-100 (0.64, P < 0.001) and SEDAN (0.71, P = 0.01). Likewise, TURN predicted 90-day mRS ≤1 with OR significantly higher than Stroke-TPI (2.89, P = 0.05), DRAGON (2.29, P = 0.01), ASTRAL (1.15, P < 0.001), HAT (2.71, P = 0.04) and SEDAN (2.15, P = 0.01), and with AUROC significantly higher than SPAN-100 (0.58, P < 0.001) and SEDAN (0.70, P = 0.01). Similar results were obtained using 90-day BI and 90-day GOS scores.

Conclusions

TURN predicted 90-day outcome with comparable or better accuracy compared to several existing clinical scores.

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Acknowledgments

The NINDS dataset was purchased using internal funds from the Yale Department of Neurology. A laptop computer for statistical analyses was purchased using funds from the Yale Lowe Endowment fund.

Conflict of interest

None.

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Authors and Affiliations

  1. Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA

    David Asuzu, Joseph Schindler, Charles Wira, David Greer & Kevin N. Sheth

  2. Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, New Haven, CT, USA

    Karin Nyström, Joseph Schindler, Charles Wira, David Greer, Janet Halliday & Kevin N. Sheth

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  1. David Asuzu
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Correspondence to Kevin N. Sheth.

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Asuzu, D., Nyström, K., Schindler, J. et al. TURN Score Predicts 90-day Outcome in Acute Ischemic Stroke Patients After IV Thrombolysis. Neurocrit Care 23, 172–178 (2015). https://doi.org/10.1007/s12028-015-0154-5

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