Abstract DP213: Development and Validation of a Grading Scale to Predict Functional Outcome in Acute Stroke Patients Treated with Intravenous Thrombolytics in the Rural Setting – The GOAT-R score

Objective: To develop a predictive tool that is accurate and easy to use for short-term functional outcomes for ischemic stroke patients treated with thrombolysis in the rural setting. Methods: This multicenter retrospective study utilized an Integrated Health System Rural Stroke Network Registry as a derivation cohort and a large urban academic hospital with a Comprehensive Stroke Center designation database as a validation cohort. Demographics, clinical, laboratory, and radiographic data were collected. A poor short-term outcome was defined as a 30-day mRS score of 5 or higher. A backward logistic regression analysis was developed based on the clinical significance of the dependent variables, and a 5-point predictive score system (GOAT-R) was developed based on clinical plausibility and practicality. A calibration curve was designed. The score was tested on the validation cohort. P-value was set at 0.05 for all statistical analyses. Results: Of 222 patients included in the derivation cohort, 35 (16%) had a poor short-term outcome. In a backward logistic regression model, baseline mRS (OR:1.511, 95% CI:1.047-2.182, p=0.02), and NIHSS (OR:1.136, 95% CI:1.063-1.214, p<0.01) were independently associated with poor short-term outcome. Age also showed a strong trend toward significance (OR: 1.045, 95% CI: 0.995-1.093, p = 0.05). Additional variables were re-entered in the final predictive model based on clinical plausibility and practicality. The 5-point predictive score GOAT-R was then created, adding one point for each of the following variables: age > 75, cardiac disease, baseline mRS > 2, NIHSS ≥ 20, and GFR < 40. The c-statistic of the model was 0.79, 95% CI: 0.71 – 0.87. In the validation cohort of 200 patients, the model performed with a c-statistic of 0.75, 95% CI: 0.64 – 0.86. Conclusions: The GOAT-R score is an accurate and easy-to-use aiding tool to help providers in rural settings guide early conversations with stroke patients and their families. Providing rural settings with inexpensive and accurate prognostic tools is a crucial step in bridging the gap in stroke care between urban and rural areas.