Evaluating the performance of the PRISMA-7 frailty criteria for predicting disability and death after acute ischemic stroke


      • The PRISMA-7 questionnaire is a simple tool to diagnose frailty that can be easily applied in the context of acute stroke.
      • The predictive performance of the PRISMA-7 in acute stroke was similar to that of the Frailty Index and the NIHSS.
      • PRISMA-7 scores ≥ 3 were associated with an 89% probability of being disabled or dead 90 days after the stroke.
      • All participants with a PRISMA-7 score ≥ 3 and an NIHSS ≥ 16 were either disabled or dead 90 days after the stroke.



      We aimed to evaluate the predictive performance of the PRISMA-7 frailty criteria regarding the composite outcome of disability or death in patients with an acute ischemic stroke, and to compare it with the Frailty Index and the National Institutes of Health Stroke Scale (NIHSS).

      Materials and methods

      This prospective cohort study involved all patients aged ≥ 40 years admitted with an acute ischemic stroke between March 2019 and January 2020. We performed survival analyses, calculated risk ratios, sensitivity, specificity, and predictive values for the combined outcome of disability or death according to the presence of frailty as determined by the PRISMA-7 and the Frailty Index, and stroke severity based on the NIHSS.


      In 174 patients with acute ischemic stroke, being frail in the week before the stroke according to the PRISMA-7 was associated with a Risk Ratio of 4·50 (95%CI 1·77-11·43, P <0·001) and a Positive Predictive Value of 89% (95%CI 77-99%) for being disabled or dead 90 days after the stroke, and a Hazard Ratio of 3·33 (95%CI 1·48-7·51, P = 0·004) for the survival outcome. The predictive performance of the PRISMA-7 was not significantly different from the Frailty Index or the NIHSS.


      We provide evidence that the PRISMA-7 frailty criteria may be a useful prognostication tool in acute ischemic stroke.


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