PLAN Score for Stroke

Why Use

Simple, rapid, and nonspecialist-friendly; can be performed at the bedside without imaging. Predicts 30-day mortality, severe disability at discharge (i.e., Modified Rankin Score >4), and 1-year mortality, which may guide discussions with patients and families/caretakers. Performs comparably to other prognostic tools (e.g. iScore, ASTRAL ) for predicting poor outcomes and mortality ( Matsumoto et al. 2020 , Wang et al. 2017 ).

When to Use

Use at the time of hospital admission for adults with acute ischemic stroke to provide an early bedside prognosis.

Formula

Pearls / Pitfalls

Developed and validated in ischemic stroke registries; subsequent analysis by Du et al. (2020) suggests it may also have utility in intracerebral hemorrhage. Derivation pre-dated widespread endovascular procedures and excluded patients treated with IV tPA; however, validation studies have shown good predictive performance even in tPA-treated patients. Demonstrates consistent discrimination with AUROC ≥0.80 across endpoints. Does not incorporate imaging, lab data, or all potentially influential comorbidities.

Advice

Use this score to augment, but not replace, NIHSS, imaging, and clinical judgement when framing prognosis and guiding treatment discussions. Results should not be used to support or withhold reperfusion therapies. Be aware that a patient’s stroke trajectory may evolve in the days following onset; reassessment may provide a more reliable prognosis.

More Information

PLAN Score 30-Day Mortality, % Severe Disability*, % 1-Year Mortality, % <6 0.7 0.9 2.1 6 1.9 1.2 4.8 7 1.4 1.3 4.5 8 2.1 2.5 6.4 9 4.4 4.3 13.1 10 4.4 6.0 16.2 11 7.6 9.8 21.7 12 10.9 14.8 26.3 13 15.3 20.3 32.0 14 21.7 30.7 42.2 15 29.0 35.8 46.0 16 35.4 43.9 57.7 17 42.5 54.4 63.3 18 50.5 65.0 74.3 19 61.2 73.2 73.8 >19 65.9 78.4 83.6 *Defined as Modified Rankin Scale 5-6 at discharge.