THRIVE Score for Stroke Outcome

THRIVE Score for Stroke Outcome
NIHSS Score
Age
History of Hypertension
History of Diabetes Mellitus
History of Atrial Fibrillation
THRIVE Score: –
Select all criteria
–
Estimates prognosis after an acute ischemic stroke.

Why Use

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.

When to Use

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

Formula

The THRIVE Score is calculated by the addition of the selected points: Variable Points Age ≤59 0 60-79 1 ≥80 2 NIH Stroke Scale (NIHSS) ≤10 0 11-20 2 ≥21 4 History of hypertension No 0 Yes 1 History of diabetes mellitus No 0 Yes 1 History of atrial fibrillation No 0 Yes 1 The probability of good outcome is calculated by the following: CDS = Hypertension + Diabetes + Atrial Fibrillation If CDS = 1, then CDS1 = 1, CDS2 = 0, and CDS3 = 0 If CDS = 2, then CDS1 = 0, CDS2 = 1, and CDS3 = 0 If CDS = 3, then CDS1 = 0, CDS2 = 0, and CDS3 = 1 If LVO = No or unknown, x = 4.942 – 0.035*Age – 0.190*NIHSS – 0.105*CDS1 – 0.408*CDS2 – 0.702*CDS3 If LVO = Yes and ASPECTS = Unknown, With EVT: x = 2.864 – 0.025*Age – 0.106*NIHSS – 0.469*CDS1 – 0.502*CDS2 – 1.665*CDS3 + 0.753*1 Without EVT: x = 2.864 – 0.025*Age – 0.106*NIHSS – 0.469*CDS1 – 0.502*CDS2 – 1.665*CDS3 + 0.753*0 If LVO = YES and ASPECTS value entered, With EVT: x = 1.828 – 0.031*Age – 0.097*NIHSS – 0.462*CDS1 – 0.419*CDS2 – 1.798*CDS3 + 0.848*1 + 0.153*ASPECTS Without EVT: x = 1.828 – 0.031*Age – 0.097*NIHSS – 0.462*CDS1 – 0.419*CDS2 – 1.798*CDS3 + 0.848*0 + 0.153*ASPECTS Probability of good outcome = 1/(1+e -x )

Pearls / Pitfalls

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.

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.

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.

Oh hi there 👋
It’s nice to meet you.

New scoring tools, dose references, and guideline summaries straight to your inbox.

We don’t spam! Read our privacy policy for more info.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *