THRIVE Score for Stroke Outcome

id

1706

full_title

THRIVE Score for Stroke Outcome

short_title

THRIVE Score

med_description

Estimates prognosis after an acute ischemic stroke.

description

The THRIVE Score for Stroke Outcome estimates prognosis after an acute ischemic stroke.

keywords

THRIVE, stroke outcome, thrive prognosis, stroke prognosis, 90 day stroke, thrive stroke, thrive outcome calc, stroke prognosis calc, thrive stroke, thrive s/p stroke, 90 day stroke outcome, thrive score, thrive prognosis, thrive stroke score, thrive 90 day, s/p acute stroke thrive, thrive calc, thrive calc cva, thrive calc stroke, ischemic stroke predictor, ischemic stroke predict, ischemic stroke outcome predict, ischemic stroke prognosis, ischemic stroke px

complaint

[ "Weakness" ]

formula

The THRIVE Score is calculated by the addition of the selected points: 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)

evidence

• The THRIVE score was originally derived using data from two single-arm trials of subjects with ischemic stroke who were treated with a thrombectomy device.

• The 0-9 point score was found to be strongly predictive of neurological outcome (as measured by the Modified Rankin Score) and mortality at 90 days (Flint 2010).

• The THRIVE score was subsequently validated to predict post-stroke outcomes and risk of symptomatic intracranial hemorrhage (sICH) in a range of settings, including use of IV thrombolysis (Kamel 2013), use of endovascular retrievable stent devices (Flint 2014; Flint 2013), and overall ischemic stroke patients (Flint 2013). 

• Using data from 12207 subjects from the Virtual International Stroke Trials Archive and the Safe Implementation of Thrombolysis in Stroke - Monitoring Study (SITS-MOST), a more precise version was developed and validated that better estimates individual patient outcomes: the THRIVE-c calculation (Flint 2015).

• Using data from 1582 subjects randomized in 7 RCTs of endovascular stroke treatment, a new set of THRIVE predictive equations (THRIVE-EVT) were developed and validated that estimate the chance of good outcome with or without endovascular treatment (EVT) (Flint 2022).

measurements

[ { "name": "Age in years", "unit": "age_years_imm", "error_min": "0.001", "error_max": "120", "warn_min": "0.1", "warn_max": "100", "conversion": "1", "normal_max_si": "0", "normal_max_us": "0", "normal_min_si": "0", "normal_min_us": "0", "units_si": " years", "units_us": " years" }, { "name": "NIH Stroke Scale", "unit": "nihss", "error_min": "0", "error_max": "42", "warn_min": "0", "warn_max": "42", "conversion": "1", "normal_max_si": "42", "normal_max_us": "42", "normal_min_si": "0", "normal_min_us": "0", "units_si": "points", "units_us": "points" } ]

information

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/20223889", "text": "Flint AC, Cullen SP, Faigeles BS, Rao VA. Predicting long-term outcome after endovascular stroke treatment: the totaled health risks in vascular events score. AJNR Am J Neuroradiol. 2010 Aug;31(7):1192-6. doi: 10.3174/ajnr.A2050. Epub 2010 Mar 11. PubMed PMID: 20223889." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/25042855", "text": "Flint AC, Gupta R, Smith WS, Kamel H, Faigeles BS, Cullen SP, Rao VA, Bath PM, Wahlgren N, Ahmed N, Donnan GA; SITS International and VISTA-plus investigators. The THRIVE score predicts symptomatic intracerebral hemorrhage after intravenous tPA administration in SITS-MOST. Int J Stroke. 2014 Aug;9(6):705-10. doi: 10.1111/ijs.12335. Epub 2014 Jul 15. PubMed PMID: 25042855." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/26045081/", "text": "Flint AC, Rao VA, Chan SL, et al. Improved ischemic stroke outcome prediction using model estimation of outcome probability: the THRIVE-c calculation. Int J Stroke. 2015;10(6):815-821." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/35319310/", "text": "Flint AC, Chan SL, Edwards NJ, et al. Outcome prediction in large vessel occlusion ischemic stroke with or without endovascular stroke treatment: THRIVE-EVT. Int J Stroke. 2023;18(3):331-337." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/22928705", "text": "Flint AC, Kamel H, Rao VA, Cullen SP, Faigeles BS, Smith WS. Validation of the Totaled Heath Risks In Vascular Events (THRIVE) score for outcome prediction in endovascular stroke treatment. Int J Stroke. 2012 Aug 29. doi: 10.1111/j.1747-4949.2012.00872.x. [Epub ahead of print] PubMed PMID: 22928705." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/23122722", "text": "Kamel H, Patel N, Rao VA, Cullen SP, Faigeles BS, Smith WS, Flint AC. The Totaled Health Risks in Vascular Events (THRIVE) Score Predicts Ischemic Stroke Outcomes Independent of Thrombolytic Therapy in the NINDS tPA Trial. J Stroke Cerebrovasc Dis. 2012 Nov 2. doi:pii: S1052-3057(12)00311-4. 10.1016/j.jstrokecerebrovasdis.2012.08.017. [Epub ahead of print] PubMed PMID: 23122722." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/24844862/", "text": "Flint AC, Cullen SP, Rao VA, et al. The THRIVE score strongly predicts outcomes in patients treated with the Solitaire device in the SWIFT and STAR trials. Int J Stroke. 2014;9(6):698-704." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/24072003/", "text": "Flint AC, Xiang B, Gupta R, et al. THRIVE score predicts outcomes with a third-generation endovascular stroke treatment device in the TREVO-2 trial. Stroke. 2013;44(12):3370-3375." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/24072004/", "text": "Flint AC, Faigeles BS, Cullen SP, et al. THRIVE score predicts ischemic stroke outcomes and thrombolytic hemorrhage risk in VISTA. Stroke. 2013;44(12):3365-3369." } ], "Validations": [] }

pearls

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.

usecase

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

reasons

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.

next_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.

next_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.

next_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.

diseases

[ "Stroke/TIA" ]

instructions

published

2022-04-21T20:28:58.434Z

purpose

[ "Prognosis" ]

search_terms

[ "stroke", "tpa", "neuro", "tia", "cva" ]

seo

{ "keywords_en": "THRIVE, stroke outcome, thrive prognosis, stroke prognosis, 90 day stroke, thrive stroke, thrive outcome calc, stroke prognosis calc, thrive stroke, thrive s/p stroke, 90 day stroke outcome, thrive score, thrive prognosis, thrive stroke score, thrive 90 day, s/p acute stroke thrive, thrive calc, thrive calc cva, thrive calc stroke, ischemic stroke predictor, ischemic stroke predict, ischemic stroke outcome predict, ischemic stroke prognosis, ischemic stroke px", "meta_description_en": "The THRIVE Score for Stroke Outcome estimates prognosis after an acute ischemic stroke." }

specialty

[ "Critical Care", "Critical Care (Neurologic)", "Hospitalist Medicine", "Internal Medicine", "Neurology" ]

departments

[ "Neurologic" ]

tags

[]

version_number

1

versions

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related

[ { "calcId": 1934, "short_title_en": "tPA Contraindications", "slug": "tpa-contraindications-ischemic-stroke" }, { "calcId": 1890, "short_title_en": "Modified Rankin Scale", "slug": "modified-rankin-scale-neurologic-disability" }, { "calcId": 715, "short_title_en": "NIH Stroke Scale (NIHSS)", "slug": "nih-stroke-scale-score-nihss" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "neurology" ]

cleaned_use

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

pub

true