PLAN Score for Early Stroke Outcome
Preadmission comorbidities, Level of consciousness, Age, and Neurological deficit (PLAN) score. Predicts in-hospital complications, discharge destination, and 30-day mortality in acute ischaemic and haemorrhagic stroke patients. Score 0-25. Higher score = worse outcome. Validated by O'Donnell et al. 2012 in 1,081 stroke patients. Useful for resource allocation and ICU admission decisions.
Score interpretation
PLAN 0-4 -- lower risk of in-hospital complications and 30-day mortality
→ Standard stroke unit care; active treatment if eligible (thrombolysis/thrombectomy); early rehabilitation; dysphagia screening; secondary prevention; early supported discharge likely; document PLAN score; good prognosis for survival and functional outcome.
PLAN 5-10 -- moderate risk of complications and mortality
→ Stroke unit with monitoring; treat comorbidities concurrently; palliative care input if appropriate; family involvement in care; intensive rehabilitation; consider HDU if PLAN above 8; document goals of care discussion; reassess prognosis at 48-72 hours.
PLAN above 10 -- high risk of in-hospital complications and mortality
→ ICU or HDU admission; intensive monitoring; early goals of care discussion with family; prognostication -- frank but compassionate; palliative care referral; consider decompressive surgery for malignant MCA/cerebellar infarcts in selected patients; DNACPR and ceiling of treatment discussion; document thoroughly; comfort measures if palliative pathway chosen.
Interpretation bands for the PLAN Score. Apply clinical judgement and local guidance.
References
- O'Donnell MJ et al. The PLAN score for stroke outcome prediction at admission. BMJ Open. 2012;2(5):e001587.
Related
Curated clinical cross-links plus same-class fallbacks.
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Edoxaban (AF Stroke Prevention / VTE) · Direct Factor Xa Inhibitor (DOAC)
- Clopidogrel (Stroke/TIA Secondary Prevention) · Antiplatelet (P2Y12 Inhibitor)
- Dabigatran (Stroke Prevention — AF) · Direct Oral Anticoagulant — Thrombin Inhibitor
- Rivaroxaban (Stroke Prevention — AF) · Direct Oral Anticoagulant — Factor Xa Inhibitor
- 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.