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THRIVE Score for Stroke Outcome

Estimates prognosis after an acute ischemic stroke.

years

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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