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    THRIVE Score for Stroke Outcome

    Estimates prognosis after an acute ischemic stroke.
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    When to Use
    Pearls/Pitfalls
    Why Use

    The THRIVE score can help physicians predict several key outcomes in patients suffering an ischemic stroke.

    The Total Health Risk In Vascular Events (THRIVE) score uses NIHSS score, age, and chronic disease to predict long-term neurologic outcomes in stroke patients.

    • Scored on a 0-9 point scale, lower is better.
      • A score of 0 predicts a 79-88% chance of a good neurological outcome and 0-2% predicted mortality at 90 days.
      • A score of 9 predicts a 7-16% chance of a good neurological outcome and 38-58% mortality at 90 days.
      • Note: A newer outcome measure is now performed using the THRIVE-c calculation, which uses continuous age and NIHSS to more accurately determine outcome probability.
    • Risk of hemorrhagic conversion increases proportionally for each additional point in the THRIVE score.
    • The THRIVE score performs well when applied to stroke patients who received IV tPA as well as patients who did not receive thrombolysis or endovascular intervention.

    Points to keep in mind:

    • The THRIVE score has been validated only retrospectively in various stroke databases and has not been applied prospectively.

    There are nearly 800,000 cases of acute stroke in the United States every year, with 130,000 associated deaths (4th leading cause of death in Americans).

    The THRIVE score can help physicians predict functional outcome, death after stroke, and the risk of brain hemorrhage after IV tPA administration in patients who suffer an ischemic stroke.

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    Next Steps
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    Advice

    • Consult Neurology immediately (if available) for all patients presenting with ischemic stroke.
    • Evaluate whether the patient is a potential candidate to receive intravenous thrombolysis (tPA).
    • Consider further imaging including CT, CT angiography and MRI/MRA.

    Management

    In patients who present with symptoms concerning for ischemic stroke:

    • Consult Neurology immediately (if available) for all patients presenting with ischemic stroke.
    • Determine the onset of stroke symptoms (or time patient last felt or was observed normal).
    • Consider further imaging including CT, CT angiography and MRI/MRA.
    • In appropriate circumstances and in consultation with both neurology and the patient, consider IV thrombolysis for ischemic strokes in patients with no contraindications.
    • Always consider stroke mimics in the differential diagnosis, especially in cases with atypical features (age, risk factors, history, physical exam), including:
      • Recrudescence of old stroke from metabolic or infectious stress;
      • Todd’s paralysis after seizure;
      • Complex migraine;
      • Pseudoseizure, conversion disorder.

    Critical Actions

    • The THRIVE score provides reliable early information about the baseline odds of recovery and prognosis in an acute ischemic stroke patient.
    • This information may help guide physicians as well as inform discussions with patients and their families when weighing the risks and benefits of various treatment options.
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    About the Creator
    Dr. Alexander Flint
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