Peter Hannon, MD

Flint AC, Faigeles BS, Cullen SP, Kamel H, Rao VA, Gupta R, et al. THRIVE Score Predicts Ischemic Stroke Outcomes and Thrombolytic Hemorrhage Risk in VISTA. Stroke. 2013


Prediction of outcomes after stroke is tricky business, and a lot of time and energy has gone into finding effective tools to help with this. Validated clinical predictors such as ASPECTS, DRAGON, HIAT-2 and iScore, to name a few, vary in complexity and what kind of imaging, if any, is needed to help predict outcome. Utilizing the Virtual International Stroke Trials Archive (VISTA), authors Flint et al. describe using the Totaled Health Risks in Vascular Events (THRIVE) score to predict outcomes after ischemic stroke and risk after IV tPA administration.


Originally described in 2010 as a tool to predict outcomes after endovascular intervention, the THRIVE score is based on age, NIHSS, and whether or not a patient has HTN, DM and/or Afib. In this study, a THRIVE score was evaluated for 5724 stoke patients reviewed in the VISTA database, then rated against outcomes at 3 months and whether there was hemorrhage after tPA intervention. Additionally, the THRIVE score was compared head-to-head to HIAT, HIAT-2 and SPAN-100 for outcomes prediction. Per authors, the THRIVE score strongly predicts clinical outcome, mortality, and the risk of hemorrhage after IV tPA, and was found to be superior to HIAT, HIAT2, HAT and SPAN-100 in several direct comparisons using ROC curve analysis. 


The THRIVE score is advantageous in its simplicity, specifically that imaging is not required, and can be quickly and easily performed at the bedside. While there is no foolproof method to predict outcomes after stroke, it is becoming increasingly evident that there are a number of ‘sweet spots’ of combinations of CVA risk factors and imaging modalities that can be rapidly utilized to give us guidance. This study highlights the usefulness of simple and efficient clinical outcomes prediction scores, as well as the invaluable role that large scale stroke trials databases play in validating them.