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. 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.
Score interpretation
ASTRAL ≤ 30: below the score of 31 at which the derivation study predicted a 50 % probability of an unfavourable outcome (mRS 3–6) at 3 months. The probability still rises with every point.
→ Prognostic only — never a reason to withhold thrombolysis, thrombectomy or stroke-unit care. Use alongside clinical judgement.
ASTRAL ≥ 31: 50 % or higher predicted probability of an unfavourable outcome (mRS 3–6) at 3 months (Ntaios 2012).
→ Prognostic only — do not withhold eligible acute treatment. Discuss prognosis with the patient and family in non-deterministic terms with the stroke team; the score informs, not decides, goals of care.
Interpretation bands for the ASTRAL Score. Apply clinical judgement and local guidance.
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).
Related
Curated clinical cross-links plus same-class fallbacks.
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Hydrocortisone (Oral Replacement) · Glucocorticoid Replacement
- Morphine (Oral) · Strong Opioid Analgesic — Step 3 WHO Ladder
- Oxycodone · Strong Opioid Analgesic — Step 3 WHO Ladder
- Donanemab (Anti-Amyloid Monoclonal Antibody) · Anti-Amyloid Immunotherapy (IgG1 — Targets Pyroglutamate-Modified Amyloid-β)
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.