PREDICTION OF FUNCTIONAL OUTCOME AND TISSUE LOSS IN ACUTE CORTICAL INFARCTION

Objective: To compare the acute Alien's Prognostic Score, Canadian Neurological Score, and subacute Barthel Index as predictors of outcome functional status and infarct size at 3 months in patients with acute cortical infarction. Design: A prospective study of acute stroke predictors and outcome measurements in a cohort of sequential hospitalized patients. Patients: Fifty-one patients with acute cortical infarction and without previous disability assessed 24 hours after onset with Alien's Prognostic Score and the Canadian Neurological Score and at 7 days with the Barthel Index. Main Outcome Measures: Mortality, Barthel Index, and volumetric measurement of infarct size on computed tomography 3 months after stroke. Results: There were seven deaths. The outcome Barthel Index was measured in all 44 survivors, of whom 29 had computed tomography at the time outcome was determined. In a multivariate analysis, functional outcome was best predicted by Alien's Prognostic Score, a score of less than -15 having a sensitivity of 82% and specificity of 97% in predicting a poor outcome (Barthel Index, less than or equal to 12 or death). Volumetric tissue loss was predicted only by Alien's Prognostic Score (r=.62, P<.001). Conclusions: Alien's Prognostic Score is a robust predictor of both functional outcome and tissue loss in acute cortical infarction and has a potentially important role in the analysis of the results of acute stroke intervention trials.