Predicting Outcome of IV Thrombolysis-Treated Ischemic Stroke Patients: The Dragon Score

Introduction: All acute ischemic stroke patients won’t respond to IV Thrombolysis, as only half of the patients achieve recanalization. A reliable scoring for prediction of outcome of acute ischemic stroke patients treated with IV alteplase would be useful for following reasons: 1) early estimation of prognosis and 2) early identification of patients who have a very high likelihood for a poor outcome despite IV thrombolytic treatment. One such reliable scoring system is DRAGON score. Our aim is to predict outcome in acute ischemic stroke patients who have been thrombolysed using DRAGON SCORE which is simple, fast and cost-effective. Objective: To assess the reliability of the DRAGON score in predicting the functional outcomes in ischemic stroke patients treated with intravenous (IV) alteplase. Methodology: This cross-sectional analytical study included 44 patients with acute ischemic stroke who were treated with IV thrombolysis at the Department of Neurology, TVMCH, between April 2022 and October 2023. Key pre-treatment variables such as computed tomography (CT) findings, baseline National Institutes of Health Stroke Scale (NIHSS), age, blood glucose levels, and onset-to-treatment time were evaluated to derive the DRAGON score. The primary outcome was the modified Rankin Scale (mRS) score at discharge, which was correlated with the initial DRAGON score to predict functional outcomes. Results: The DRAGON score, a 10-point scale based on CT findings, NIHSS, and other clinical parameters, demonstrated a significant correlation with functional outcomes at discharge. Patients with lower DRAGON scores (<4) were associated with favourable outcomes (mRS ≤3), while those with higher scores (>7) were more likely to experience poor recovery or death. The area under the curve (AUC) for predicting favourable outcomes was 0.768, with a sensitivity and specificity of 75%. Conclusion: The DRAGON score is a simple, quick, and cost-effective tool for predicting the outcome of ischemic stroke patients treated with IV alteplase. It can help in early decision-making, particularly in identifying patients who may benefit from additional interventions like mechanical thrombectomy. Further studies with larger sample sizes are necessary to validate these findings and assess long-term outcomes.