The Orpington Prognostic Scale Within the First 48 Hours of Admission as a Predictor of Outcome in Ischemic Stroke Sean J. Pittock, MD, Dara Meldrum, MSc, Caoimhe Ni Dhuill, MB, Orla Hardiman, MD, and Joan T. Moroney, MD This study investigates the prognostic ability of the Orpington Prognostic Scale within 48 hours (OPS-1) after admission in predicting outcome at 6 months and 2 years in acute ischemic stroke and compares it with the 2 week OPS (OPS-2). All consecutive ischemic stroke patients (n = 117) were scored on the OPS, Barthel activities of daily living, Oxford handicap scale, European stroke scale, and River- mead motor assessment at 48 hours, 2 weeks, 6 months, and 2 years post-stroke. Baseline OPS scores at 48 hours and 2 weeks were used to predict outcomes at 6 months and 2 years. The OPS-1 was an excellent predictor of length of hospital stay (P  .001), place of discharge (P  .01), and outcome at 6 months and 2 years (P  .0001, Fisher’s exact). The OPS-2 was marginally better than the OPS-1 though this benefit was outweighed by the earlier stratification of the 48-hour measure. The sensitivity, specificity, and positive predictive values (PPV) of the “good” OPS-1 versus the OPS-2 at predicting independence at 6 months were 85% vs 92%, 85% vs 63% and 87% vs 92%, respectively. The sensitivity, specificity, and PPV of the “poor” OPS-1 versus OPS-2 were 48% v 35%, 97% v 100%, and 93% v 100% respectively. The OPS at 48 hours is a good predictor of outcome at 6 months and 2 years after ischemic stroke and allows early identification of 3 prognostic groups, which may help in identifying patients most likely to benefit from intensive rehabilitation. Key Words: Cerebrovascular diseases— outcome—prognostic indi- cator—stroke. Copyright © 2003 by National Stroke Association Accurate prediction of outcome in stroke is a highly desirable goal and helps assist with discharge and service planning, helps assist with patient and family decision making, and allows the physician to access the risks associated with any proposed treatment. Stroke is a major cause of mortality and morbidity, results in a significant health care cost, and is the most important single cause of severe disability in the western world. 1-7 Over the past 30 years, there has been an increasing number of scales that seek to quantify neurological impair- ment, all of which have attendant difficulties in reliably assessing outcome with respect to disability or neurological deficit in a heterogeneous patient population. 8-21 In addi- tion, many impairment scales been used to predict outcome despite not having been designed for this purpose. In contrast, the Orpington Prognostic Score (OPS), a clinically derived, quick to perform score, requiring no extensive training, incorporates measures of motor defi- cit, proprioception, balance, and cognition and is specif- ically used as a prognostic indicator. 22 The OPS at 2 weeks after stroke (OPS-2) was shown to be a useful indicator for 14-weeks post-stroke activities of daily liv- ing (ADL) scores and discharge disposition, and when compared with the National Institute of Health (NIH) From the Department of Neurology, Beaumont Hospital, Dublin, Ireland. Received April 9, 2003; accepted July 7, 2003. Supported in part by a scholarship grant from Schering AG, Ireland. Address reprint requests to Sean Pittock, MD, Department of Neurology, 200 First Street SW, Mayo Clinic, Rochester, MN 55901. E-mail: pittock.sean@mayo.edu Copyright © 2003 by National Stroke Association 1052-3057/03/1204-0000$30.00/0 doi:10.1016/S1052-3057(03)00078-8 Journal of Stroke and Cerebrovascular Diseases, Vol. 12, No. 4 (July-August), 2003: pp 175-181 175