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    Patent Pending

    ASTRAL Score for Ischemic Stroke

    Predicts 90-day poor outcome in patients with acute ischemic stroke.

    INSTRUCTIONS

    Use in patients with acute ischemic stroke admitted within 24 hours of stroke onset.
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with acute ischemic stroke admitted within 24 hours of stroke onset.

    • The ASTRAL Score uses clinical characteristics and laboratory testing to predict the likelihood that a given patient with acute ischemic stroke will have a Modified Rankin Scale result of 3–6 at 90 days after stroke.
    • Developed to predict a dichotomous outcome, not a discrete Modified Rankin Scale score at 90 days.
    • Does not predict mortality or degree of improvement from any form of rehabilitation.
    • Should not be used as a surrogate for stroke severity.
    • Can provide additional information on medium-term functional outcome in patients that have suffered acute ischemic stroke, in addition to clinical judgment based on relevant clinical and laboratory variables.
    • Does not need neuroimaging data to calculate.
    • Can be used to adjust for functional outcome in multivariate models in acute stroke-related research studies.
    • Can serve as a selection criterion for cohorts in acute stroke-related research studies.
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    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. George Ntaios

    About the Creator

    George Ntaios, MD, PhD, is an assistant professor of internal medicine at the University of Thessaly in Larissa, Greece. He is co-chair of the Guidelines Committee of the European Stroke Organization and Secretary General of the Hellenic Stroke Organization. Dr. Ntaios is an active researcher, focusing mainly on secondary stroke prevention and stroke prognosis.

    To view Dr. George Ntaios's publications, visit PubMed

    Dr. Patrik Michel

    From the Creator

    Why did you develop the ASTRAL Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

    Our daily work with acute stroke patients taught us that our gut feeling about which patient would recover well was wrong in about a third of patients.

    What pearls, pitfalls and/or tips do you have for users of the ASTRAL Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?

    Like with every score, it is not perfect and surprisingly short for a complex problem, which is long-term prognosis after stroke. Our two pieces of advice:

    1. Always use it together with other information that may not be in the score, and
    2. Use the score only for patients with pre-stroke independence (Modified Rankin Scale 0-2 points). Patients who were already dependent before the stroke will in general remain so after three months.

    What recommendations do you have for doctors once they have applied the ASTRAL Score? Are there any adjustments or updates you would make to the score based on new data or practice changes?

    The information of the calculated score should add to, not replace, the estimation of prognosis.

    We have already shown that adding basic imaging information adds little to the score. However, we feel that adding subacute clinical information, such as the NIHSS or temperature at 24 hours, could add further precision to the score.

    How do you use the ASTRAL Score in your own clinical practice? Can you give an example of a scenario in which you use it?

    We use it in the acute phase when discussing difficult situations with the next of kin. For example, "Your mother, who was still at home, now had a moderately severe stroke; from our estimation, she has an approximately 60% chance of being dependent (or dead) in three months. Does this help you in your wish for how aggressive we should be in our management in the next few days in the stroke unit?"

    Any other research in the pipeline that you’re particularly excited about?

    We are currently nearly finished with:

    1. A new score predicting stroke recurrence in the first 12 months after an ischemic stroke.
    2. A new clinical prehospital score which predicts not only which patients have a large (proximal) vessel occlusion for possible thrombectomy, but also does so up to 24 hours, and predicts who has a good chance of responding to thrombectomy. 

    About the Creator

    Patrik Michel, MD, is a professor in the department of neurology at the University of Lausanne in Switzerland. He is chief of the Cerebrovascular Center there, which he also established. Dr. Michel is active in many professional organizations, including the European Stroke Organization and the World Stroke Organization.

    To view Dr. Patrik Michel's publications, visit PubMed

    Are you Dr. Patrik Michel? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    About the Creator
    Dr. George Ntaios
    Dr. Patrik Michel
    Are you Dr. Patrik Michel?
    Content Contributors