DRAGON score for post tPA stroke outcome
This model predicts the 3 month outcome in ischemic stroke patients receiving tissue plaminogen activator (tPA).

Research authors: Strbian D, Meretoja A, Ahlhelm FJ, Pitkäniemi J, Lyrer P, Kaste M, Engelter S, Tatlisumak T.
Details Formula Study characteristics Files & References
★★★★
Model author
Model ID
302
Version
1.16
Revision date
2016-04-25
Specialty
MeSH terms
  • Plasminogen Activator, Tissue-Type
  • Cerebral Stroke
  • Assessment, Patient Outcome
  • Model type
    Linear model (Calculation)
    Status
    public
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    Formula
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    Condition Formula

    Additional information

    Inclusion- & exclusion criteria:
    The baseline cohort included a total of 1,529 consecutive acute ischemic stroke patients treated with IV alteplase (0.9 mg/kg body weight) according to the written institutional guidelines at the Helsinki University Central Hospital, Helsinki, Finland, between 1995 and September 2010. At total of 152 patients with basilar artery occlusion were excluded because their natural history and treatment protocol differ markedly, i.e., always including concomitant full-dose IV heparin and allowing for OTT of up to 48 hours in patients with progressing symptoms. No follow-up data were available for 27 patients, and necessary baseline parameters were not available for 31 patients, all of whom were excluded from the analyses, leaving 1,319 eligible patients treated with IV alteplase within 4.5 hours from symptom onset.

    Study Population

    Total population size: 1319
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name LL Q1 Median Q3 UL Unit
    Age 60 69 77 years
    Onset to treatment time 88 118 158 minutes
    Baseline NIHSS score 5 9 14 points
    Systolic bloodpresure before 140 156 171 mmHg
    Diastolic bloodpressure before 74 83 92 mmHg

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Hyperdense cerebral artery sign Positive sign 234
    Early infarct signs Positive sign 404
    Prestroke mRS score >1 Positive score >1 82
    Proportions of 3-month outcome, mRS score 0-2 798
    3-4 339
    5-6 182
    Hypertension Yes 787
    No 532
    Diabetes mellitus Yes 192
    No 1127
    Previous stoke Yes 168
    No 1151
    Hyperlipidemia Yes 516
    No 803
    Atrial fibrillation Yes 366
    No 953

    DRAGON score for 3-month post-tPA outcome:
    ...
    points

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    Result
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    DRAGON score for 3-month post-tPA outcome: points

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    Outcome stratification

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    Conditional information

    Result interpretation

    The DRAGON score can support clinical decision-making, especially when invasive add-on strategies are considered.

    Model performance:
    The c-index was 0.84 (0.80-0.87) in the derivation cohort and 0.80 (0.74-0.86) in the validation cohort. When tested separately for anterior and posterior circulation, there was no difference in performance (P=0.55). No sex-related difference in performance was observed (P=0.25).

    Note: the DRAGON score was not studied in patients with basilar artery occlusion. Further external validation is warranted.

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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