ASTRAL Score for Ischemic Stroke

Age

years

NIH Stroke Scale score on admission

points

Time from symptom onset (or last known well) to admission

hours

Visual field defect on admission

Acute glucose >131 mg/dL (7.3 mmol/L) or <66 mg/dL (3.7 mmol/L)

Impaired level of consciousness on admission

Complete the fields above to see the result.

When to use

Estimating 90-day functional prognosis in patients admitted within 24 hours of acute ischemic stroke onset.

Formula

ASTRAL = age (years) + admission NIHSS + 2 (if onset-to-admission delay >3 hours) + 2 (visual field defect) + 1 (acute glucose abnormality) + 3 (impaired consciousness).

Pearls and pitfalls

Derived and doubly externally validated (Lausanne, Athens, Vienna registries) with good discrimination (AUC 0.85-0.94).

References

Ntaios G, Faouzi M, Ferrari J, Lang W, Vemmos K, Michel P. An integer-based score to predict functional outcome in acute ischemic stroke: the ASTRAL score. Neurology. 2012;78(24):1916-22.