When you’re in ED and a new stroke comes in, the first question that always comes to mind is whether it can be thrombolysed – and I’d refer you to the excellent article on the topic last year from NEJM. That said, how do you predict how well someone will do after they’ve been thrombolysed?
This is where the DRAGON score comes in. It’s a combination of:
- (hyper)Dense cerebral artery sign/early infarct signs on admission CT scan (both = 2, either = 1, none = 0)
- prestroke modified Rankin Scale (mRS) score >1 (yes = 1)
- Age (≥80 years = 2, 65–79 years = 1, <65 years = 0)
- Glucose level at baseline (>8 mmol/L [>144 mg/dL] = 1)
- Onset-to-treatment time (>90 minutes = 1)
- baseline National Institutes of Health Stroke Scale score (>15 = 3, 10–15 = 2, 5–9 = 1, 0–4 = 0)
A score of 0-1 gave you a good outcome in 96%, and 100% chance of a poor outcome with a score of 10, using the modified Rankin scale as a marker. Although this was a useful score in the 1,319 patients studied here, you wonder how it will be used clinically. It shouldn’t change who you thrombolyse – but it does give you more information regarding success, particularly if you have someone who may be borderline.
The article is here.
source | Neurology
image | ConstructionDealMkting