SOAR Score for Stroke (Stroke subtype, Oxfordshire, Age, consciousness level, Rankin score)
Simple 5-variable score predicting in-hospital mortality after acute stroke. Calculated using admission data; validated across multiple stroke subtypes and settings.
Score interpretation
SOAR 0-1 -- low in-hospital mortality; good prognosis expected
→ Standard stroke unit care; IV thrombolysis if eligible (NIHSS >= 4, onset < 4.5h, no contraindications); mechanical thrombectomy if LVO confirmed on CTA; secondary prevention: antiplatelet (aspirin 300 mg loading, then dual antiplatelet for 21 days if TIA/minor stroke), statin (atorvastatin 40-80 mg), antihypertensives; early rehabilitation; early supported discharge; patient and family education.
SOAR 2-3 -- moderate in-hospital mortality risk; active treatment appropriate
→ Active stroke treatment; thrombolysis/thrombectomy if eligible; MDT rehabilitation (physiotherapy, OT, SALT, psychology); monitor for complications (aspiration pneumonia, DVT, urinary infection, pressure sores); dysphagia screen mandatory; nasogastric feeding if unsafe swallow; bladder management; early mobilisation; goals of care discussion if deterioration; SALT -- thickened fluids/modified diet as needed.
SOAR 4-5 -- high in-hospital mortality; consider ceiling of treatment
→ Early goals of care discussion with patient (if capacity) and family; consider DNACPR; ceiling of treatment documentation; palliative care referral as appropriate; continue comfort measures; good oral hygiene; pressure care; pain management; religious/spiritual support if requested; maintain communication with family; acute stroke treatment may still be warranted if onset-to-treatment within window -- SOAR does not preclude thrombolysis/thrombectomy.
SOAR 6-8 -- very high in-hospital mortality; comfort-focused care likely most appropriate
→ Immediate palliative care involvement; DNACPR and ceiling of treatment; symptom control: analgesia, anti-secretory agents (hyoscine), anxiolytics; mouth care; Liverpool Care Pathway equivalent; family presence encouraged; chaplaincy; document all decisions; MDT bereavement support planning; organise family meeting; document SOAR score, conscious level, clinical trajectory, and all treatment decisions in notes.
Interpretation bands for the SOAR Stroke Score. Apply clinical judgement and local guidance.
References
- Smith EE et al. Predicting functional outcome in acute stroke: SOAR score. Stroke. 2010;41(2):252-258.
- 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
- 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.