After stroke, patients who do not die during acute hospitalization tend to stabilize with supportive care only. Continuous decline in clinical or functional status over time means that the patient's prognosis is poor.

1. Acute phase patients
Immediately following a hemorrhagic or ischemic stroke, any of the following are strong indicators of early mortality:

____ Coma or persistent vegetative state secondary to stroke, beyond three days' duration
____ In post-anoxic stroke, coma, or sever obtundation, accompanied by severe myoclonus,
persistent beyond 3 days past the anoxic event
____ Comatose patients with any 4 of the following on day 3 of coma had 97% mortality by two months:

____ abnormal brain stem response
____ absent verbal response
____ absent withdrawal response to pain
____ serum creatinine > 1.5 mg/dl
____ age > 70

_____ Dysphagia severe enough to prevent the patient from receiving food and fluids necessary to sustain life,
in a patient who declines or is not a candidate for artificial nutrition and hydration.
_____ If available, CT or MRI scans may indicate decreased likelihood of survival

2. Chronic phase patients
The following clinical factors may correlate with poor survival.

_____ Age > 70
_____ Poor functional status as evidenced by Karnofsky score of < 50%

____ 50% Requires considerable assistance and frequent medical care
____ 40% Disabled; requires special care and assistance; unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly
____ 30% Severely disabled; hospital admission is indicated although death is not imminent
____ 20% Very sick; hospital admission necessary; active support treatment necessary
____ 10% Moribund; fatal processes progressing rapidly

____ Post stroke dementia as evidenced by a FAST score greater than 7

____ 7A Ability to speak is limited to approximately 6 intelligible words or fewer, in the course of an average day or in the course of an intensive interview
____ 7B Speech ability is limited to the use of a single intelligible word in an average day or in the course of an intensive interview (the person may repeat the word over and over)
____ 7C Ambulatory ability is lost (cannot walk without personal assistance)
____ 7D Cannot sit up without assistance (e.g. patient will fall over if there are not lateral rests (arms on the chair))
____ 7E Loss of ability to smile
____ 7F Loss of ability to hold up head independently

_____ Poor nutritional status, whether on artificial nutrition or not:

____ unintentional progressive weight loss of greater than 10% over prior six months
____ serum albumin less than 2.5 gm/dl (may be helpful prognostic indicator but should not be used by itself)

_____ Medical complications related to debility and progress clinical decline

____ aspiration pneumonia
____ upper urinary tract infection (pyelonephritis)
____ sepsis
____ refractory stage 3-4 decubitus ulcers
____ fever recurrent after antibiotics