The Boston Acute Stroke Imaging Scale: ready for use in clinical practice?

This Practice Point commentary discusses a report by Torres-Mozqueda et al. on a newly developed classification instrument for predicting outcome after stroke, the Boston Acute Stroke Imaging Scale (BASIS). This tool incorporates imaging data on the patency of the vasculature and the parenchyma and classifies ischemic strokes as major (if large vessels are occluded or parenchymal changes are present) or minor (all others). When testing the scale, the authors looked at short-term outcome at the time of hospital discharge; patients classified with major stroke by BASIS had a higher mortality and longer hospital stay and were more likely to be discharged to a rehabilitation facility than patients with minor stroke. The authors concluded that BASIS can predict outcome after stroke. We point to several shortcomings in the study methodology and argue that, although BASIS has potential as a prognostic tool, further studies are needed before it can be widely used.