neurology

ASTRAL Score for Ischaemic Stroke Outcome Prediction

ASTRAL (Acute STroke Registry and Analysis of Lausanne) score predicts unfavourable functional outcome (modified Rankin Scale 3-6) at 3 months after ischaemic stroke. Based on 6 variables assessed at admission. Score 0-50; higher score = worse outcome. AUC 0.85 for predicting poor outcome. Validated by Ntaios et al. 2012 in 1,645 patients. Useful for early prognostication and goals of care discussions.

Age (years) -- each year adds 1 point (up to 50 points max in original but we use age directly)*(years)

NIHSS score at admission (divided by 5 for score contribution -- see formula)*(NIHSS points)

Time from symptom onset to admission (hours)*

Visual field defect (hemianopia or quadrantanopia on NIHSS item 3)*

Admission glucose*

Reduced level of consciousness at admission (NIHSS level of consciousness item 1a above 0)*

References

Ntaios G et al. An integer-based score to predict functional outcome in acute ischemic stroke: the ASTRAL score. Neurology. 2012;78(24):1916-1922.
NICE NG128. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE. 2019 (updated 2023).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against MDCalc, NICE, or your local guideline before clinical use.

References

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