A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke

Adrian D Wood, Nicholas D Gollop, Joao H Bettencourt-Silva, Allan B Clark, Anthony K Metcalf, Kristian M Bowles, Marcus Flather, John F Potter, Phyo K Myint

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Background and Purpose Little is known about the factors associated with in-hospital mortality following total anterior circulation stroke (TACS). We examined the characteristics and comorbidity data for TACS patients in relation to in-hospital mortality with the aim of developing a simple clinical rule for predicting the acute mortality outcome in TACS. Methods A routine data registry of one regional hospital in the UK was analyzed. The subjects were 2,971 stroke patients with TACS (82% ischemic; median age=81 years, interquartile age range=74–86 years) admitted between 1996 and 2012. Uni- and multivariate regression models were used to estimate in-hospital mortality odds ratios for the study covariates. A 6-point TACS scoring system was developed from regression analyses to predict in-hospital mortality as the outcome. Results Factors associated with in-hospital mortality of TACS were male sex [adjusted odds ratio (AOR)=1.19], age (AOR=4.96 for ≥85 years vs. <65 years), hemorrhagic subtype (AOR=1.70), nonlateralization (AOR=1.75), prestroke disability (AOR=1.73 for moderate disability vs. no symptoms), and congestive heart failure (CHF) (AOR=1.61). Risk stratification using the 6-point TACS Score [T=type (hemorrhage=1 point) and territory (nonlateralization=1 point), A=age (65–84 years=1 point, ≥85 years=2 points), C=CHF (if present=1 point), S=status before stroke (prestroke modified Rankin Scale score of 4 or 5=1 point)] reliably predicted a mortality outcome: score=0, 29.4% mortality; score=1, 46.2% mortality [negative predictive value (NPV)=70.6%, positive predictive value (PPV)=46.2%]; score=2, 64.1% mortality (NPV=70.6, PPV=64.1%); score=3, 73.7% mortality (NPV=70.6%, PPV=73.7%); and score=4 or 5, 81.2% mortality (NPV=70.6%, PPV=81.2%). Conclusions We have identified the key determinants of in-hospital mortality following TACS and derived a 6-point TACS Score that can be used to predict the prognosis of particular patients.
Original languageEnglish
Pages (from-to)407-413
Number of pages7
JournalJournal of Clinical Neurology
Issue number4
Early online date30 Sept 2016
Publication statusPublished - Oct 2016

Bibliographical note

We thank the stroke datateam at the Norfolk and Norwich University
Hospital for providing data.
This work was supported by Stroke Services at the Norfolk and Norwich
University Hospital Foundation NHS Trust Norfolk, which maintains
the Norwich Clinical Stroke Register and Research Capability
Funding from the Norfolk and Norwich University Hospital Research &
Development Department.


  • total anterior circulation stroke
  • risk factors
  • in-hospital mortality
  • prognosis
  • prognosis score
  • advanced age


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