THRIVE Score for Ischaemic Stroke Outcome
Totalled Health Risks In Vascular Events (THRIVE) score. Predicts 90-day mortality and functional outcome in ischaemic stroke patients, particularly those treated with tPA thrombolysis or mechanical thrombectomy. Based on NIHSS, age, and comorbidities (hypertension, diabetes mellitus, atrial fibrillation). Score 0-9; higher score = worse outcome. Validated by Flint et al. 2010 in SITS-MOST and NINDS datasets.
Score interpretation
THRIVE 0-2 -- favourable prognosis; good functional outcome likely
→ Pursue all eligible acute treatments aggressively (thrombolysis, thrombectomy); stroke unit care; early rehabilitation; secondary prevention: antiplatelet (aspirin 300 mg loading then 75 mg OD, switch to clopidogrel at day 14 for most patients), statin (atorvastatin 40-80 mg OD), antihypertensives; anticoagulation if AF confirmed (DOAC preferred unless contraindicated); lifestyle modification; early supported discharge; estimated 80% chance of good 90-day outcome (mRS 0-2).
THRIVE 3-5 -- moderate prognosis; meaningful recovery possible with treatment
→ Active stroke treatment; early goals of care discussion with patient and family; frank but compassionate prognostication; intensive rehabilitation from day 1; swallow screen and SALT assessment; physiotherapy and occupational therapy from day 2; manage comorbidities (glucose control -- avoid hyperglycaemia, hypertension, AF rate/rhythm control); palliative care input if patient preference or poor trajectory; document THRIVE and MDT discussion in notes.
THRIVE 6-9 -- high mortality and disability risk; goals of care discussion essential
→ Immediate and compassionate goals of care discussion with family and patient (if capacity); THRIVE 7-9: approximately 40% 90-day mortality; acute treatments still warranted if eligible (thrombectomy for LVO, thrombolysis -- decision should not be based on THRIVE alone); DNACPR and ceiling of treatment discussion; palliative care early referral; maintain comfort: nutrition/hydration, oral hygiene, pressure care, pain management; decompressive hemicraniectomy discussion if malignant MCA infarct (age below 60 and within 48h); family support; chaplaincy/spiritual care if requested; document all discussions meticulously.
Interpretation bands for the THRIVE Score. Apply clinical judgement and local guidance.
References
- Flint AC et al. The THRIVE score predicts ischemic stroke outcomes. Stroke. 2010;41(12):2660-2667.
- 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
- Tenecteplase (Stroke) · Stroke Thrombolysis
- Alteplase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Streptokinase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Edoxaban (AF Stroke Prevention / VTE) · Direct Factor Xa Inhibitor (DOAC)
- 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.