DRAGON Score for Post-TPA Stroke Outcome

The DRAGON Score was developed in response to the need for a reliable scoring tool for prediction of long-term outcome of acute ischemic stroke patients treated with IV alteplase.

Prognostication at the time of thrombolysis is felt to be useful for 2 reasons

• 1) early estimation of prognosis
• 2) early identification of such patients who have a very high likelihood of a poor outcome despite IV thrombolytic treatment

The DRAGON score was derived from a dataset of 1,319 patients with ischemic stroke at single center. The score was validated in the original paper in an external population.

AUC-ROC was 0.84 (0.80-0.87) in the derivation cohort and 0.80 (0.74-0.86) in the validation cohort.

A large, multi-center study of 4,519 subjects with ischemic stroke which retrospectively applied the DRAGON score found that the score performed well with an AUC-ROC was 0.84 (0.82-0.85).

The score was also validated in an elderly Spanish population and a Chinese population and both found that the DRAGON score was able to distinguish between good and poor clinical outcomes.

Note that patients with basilar artery occlusions were excluded from the study.

Of note, no patient with a DRAGON score of 8-10 has a good outcome at 90 days.

Points are assigned for each of the following variables: dense cerebral artery or early infarct signs on computerized tomography, mRS modified rankin scale >1 pre-stroke, age, glucose at baseline, onset of treatment >90 minutes and baseline NIHSS.