Modified SOAR Score for Stroke
Why Use
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.
When to Use
Patients admitted with acute ischemic or hemorrhagic stroke that have mRS and NIH Stroke Scale assessments.
Formula
Pearls / Pitfalls
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.
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.
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.
More Information
Interpretation: mSOAR Score Inpatient mortality 0 1.0% 1 1.0% 2 1.5% 3 6.5% 4 9.2% 5 19.5% 6 26.2% 7 49.2% From Abdul-Rahim 2016 . Scores >7 were not reported.