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    Modified SOAR Score for Stroke

    Predicts short-term mortality in acute ischemic stroke.
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    INSTRUCTIONS

    Use admission data for calculation. Do not use in patients with transient ischemic attack, subarachnoid hemorrhage, or subdural hemorrhage.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients admitted with acute ischemic or hemorrhagic stroke that have mRS and NIH Stroke Scale assessments.

    • No single universally accepted stroke mortality prediction score exists.
    • Score is based on data present on admission and is static.
    • Does not apply to patients with transient ischemic attack, subarachnoid hemorrhage, or subdural hemorrhage.
    • Can be applied for both ischemic and hemorrhagic stroke.
    • Component variables are familiar to most clinicians.
    • Can be calculated quickly.
    • Does not necessitate a weighting algorithm.
    • Can be administered by non-MD personnel.
    • Component variables are static over a given hospitalization.
    Infarct
    0
    Hemorrhage
    +1
    LACS/PACS
    0
    POCS
    +1
    TACS
    +2
    ≤65
    0
    66-85
    +1
    >85
    +2
    0-2
    0
    3-4
    +1
    5
    +2
    0-4
    0
    5-10
    +1
    ≥11
    +2

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • The mSOAR Score may be considered in patients with acute stroke, as a predictor of short-term mortality.
    • The score should not be used as a substitute for clinical judgment, or as a sole predictive tool for mortality.

    Management

    Acute ischemic stroke and intracerebral hemorrhage (ICH) are both neurological emergencies. Patients with acute ischemic stroke, in particular, can benefit from time-sensitive treatments (e.g. tPA, mechanical thrombectomy) that can be administered if certain clinical conditions are met.

    In cases of suspected acute ischemic stroke, the following is recommended:

    • STAT neurological consultation.
    • STAT CT head without contrast.
    • STAT laboratory testing (CBC, PT/INR/aPTT, basic metabolic panel, type & screen, troponin-I).
    • Consider STAT CT angiogram of the head & neck in cases of suspected acute stroke due to large-vessel occlusion (LVO).

    In cases of confirmed acute intracerebral hemorrhage, the following is recommended:

    • Airway, breathing and circulation monitoring.
    • Immediate neurological and neurosurgical consultation.
    • Thorough medication history to identify anticoagulant and antiplatelet-associated hemorrhage.
    • Hypertensive patients with ICH should undergo blood pressure reduction with intravenous agents. The target blood pressure should be discussed with neurological or neurosurgical consultants if available.
    • Similarly, the decision to administer reversal agents (e.g. desmopressin, vitamin K), blood products (e.g. prothrombin complex concentrates, fresh frozen plasma), or anti-epileptic medications should not be made without discussion with the neurological or neurosurgical consultant if available.

    Critical Actions

    It is crucial to identify anticoagulant-associated ICH with careful medication history, and reverse with agents specifically tailored to the offending anticoagulant. 

    Platelet transfusion is not recommended in cases of spontaneous antiplatelet-related ICH.

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    About the Creator
    Dr. Phyo Kyaw Myint
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