Correlation of Alberta Stroke Program Early Computed Tomography (CT) Score Among Ischaemic Stroke Patients and Their Outcomes at Selected Centres in Kampala: A Prospective Study

TL;DR

This study shows that a CT scan scoring system (ASPECTS) can predict outcomes in stroke patients, with lower scores linked to worse results.

Contribution

The study confirms the utility of ASPECTS in predicting stroke outcomes in a specific regional context.

Findings

ASPECTS scores inversely correlated with stroke outcomes (r = -0.618, p < 0.001).

Poor outcomes were associated with lower ASPECTS, no education, and specific brain region involvement.

83.1% of patients had poor outcomes, with 26.27% mortality.

Abstract

Background

Stroke contributes significantly to morbidity and is the second leading cause of death globally. The Alberta Stroke Program Early Computed Tomography (ASPECT) Score, a 10-point scoring system with anatomical regions of the brain over the middle cerebral artery (MCA) territory, is used to assess early ischaemic changes on a non-contrast computed tomography scan (NCCT) of the head. It is used as a predictor of functional outcome and in the stratification of ischaemic stroke patients’ treatment to guide reperfusion and non-thrombolytic management. This study aimed to determine the correlation between the ASPECTS and the outcomes of ischaemic stroke patients in Kampala, Uganda.

Methods

This was a prospective study carried out at three selected centres. All patients diagnosed with ischaemic stroke involving the MCA underwent NCCT of the head to determine the ASPECTS. Enrolled participants were index admissions to the hospital following the symptoms and signs of stroke. Patient demographics, clinical presenting complaints, Glasgow Coma Scale (GCS), comorbidities, and medical and treatment history for individual patients were documented in the data collection tool. Study patients were recruited consecutively and followed up one month later using the Modified Rankin Scale (mRS). The participants’ outcomes were described as favourable outcomes and poor outcomes. Spearman correlation analysis was carried out to measure the strength and direction of association between ASPECTS and mRS.

Results

The average ASPECTS score was 5.71, SD ± 3.4, with a left hemisphere predilection. There was a significant inverse correlation between ASPECTS and mRS scores (r = -0.618, p < 0.001). 17% (n=20) had favourable outcomes (mRS, 0-2), whereas 83.1% (n=98) had poor outcomes (mRS, ≥3) with 26.27% mortality. Poor outcomes among patients were associated with overall lower ASPECTS, no education, low GCS at admission, involvement of M3 and M5 brain regions and additional vascular territory-posterior cerebral artery involvement.

Conclusion

The inverse correlation between the ASPECTS and mRS seen in this study highlights the value of the ASPECTS as a reliable tool to predict functional outcomes in ischaemic stroke patients. The poor outcomes observed reflect the need to utilise the ASPECTS to ensure appropriate timely interventions and rehabilitation and for individualised stroke protocols in our hospitals to initiate thrombolytic and thrombectomy therapy.

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