Online Tool Predicts Risk of Death from Stroke in Hospital

A new Internet-based tool, the Get With The Guidelines-Stroke (GWTG) prediction tool, can predict the risk of dying in the hospital for stroke patients, as well as help physicians develop better care plans, according to study results to appear in the October 12 issue of Circulation. Additionally, hospital-based physicians can use the tool to evaluate and improve patient outcomes.

Based on a large, nationwide sample of stroke patients, GWTG uses age, sex, presence of other illnesses, and related patient information, uploaded by a physician upon hospital admission, to perform a calculation that predicts the risk of death.

"Hospitals can use our mortality risk score to calculate the mortality rate that they would expect to see, based on the characteristics of their own patients, and compare that to their actual observed mortality," said lead author Eric Smith, MD, MPH, University of Calgary, Calgary, Canada. "This could help improve quality of care."

Getting it’s name from the American Heart Association's Get With The Guidelines program from which data was culled to develop the calculation, the tool was developed after researchers studied the medical records and demographics of 275,000 ischemic stroke patients from 2001 to 2007, then developing a mortality prediction scale based on what they found.

Although the strongest predictor of death following a stroke is the severity of that stroke as measured by the National Institutes of Health Stroke Scale (NIHSS), score, the study found that relying on this score at admission isn’t feasible because “the time needed to perform even a short standardized stroke severity assessment is probably a barrier to more widespread use.” Further, GWTG is accurate even without taking NIHSS score into consideration. “In our case, it (the mathematical calculation) indicates that the predictions are pretty accurate and probably clinically useful," said Smith.

Dr. Roger Bonomo, director, stroke center at Lenox Hill Hospital, New York, NY, said he hopes the study will help physicians, in time, improve stroke survival rates, but admitted that it currently represents “a work in progress,” adding, “Stroke is a significant cause of death and it's going to continue to be," and GWTG will help in "seeing if we're making a difference in the outcomes, changing the natural history of death that would be expected from strokes."