Simple score may help predict early stroke mortality

A simple score based on four variables easily obtainable at the point of care may help predict inpatient and 7-day mortality after acute stroke, a study found.

Four variables—the Stroke subtype, the Oxfordshire Community Stroke Project Classification, the Age, and the prestroke Rankin stroke—comprise the SOAR score. It is an 8-point scale (0-7), with each of the variables scored as 0, 1 or 2 points, taken when the patient is admitted.

To validate the SOAR score's ability to predict inpatient and 7-day mortality, British researchers used data from 3,547 stroke patients (92% ischemic) treated at eight National Health Service hospital trusts in the Anglia Stroke and Heart Clinical Network between September 2008 and April 2011.

Results appeared online June 18 at Stroke.

The best predictive value was observed for the cut-off score of 3 or above. The area under the receiver-operator curve was 0.80 (95% CI, 0.78 to 0.82) for inpatient mortality and 0.82 (95% CI, 0.79 to 0.84) for 7-day mortality.

Researchers noted that, unlike other scores, SOAR can be applied to both ischemic and hemorrhagic stroke. It can be calculated by both clinical and nonclinical staff for administrative purposes once the clinical assessment has been made, since all four factors were fixed during admission.

Still, researchers cautioned, “Although the sensitivity and specificity of the SOAR score are reasonable when cut-off point ≥3 is used, the positive predictive value was less impressive (only 23% with a SOAR score of 3 died) and this may result in some patients being assigned a misleading prognosis. As a result, clinical judgment still has a role in prognostication as the score has yet to be tested against clinical judgment.”