Validation of the DRAGON score in 12 stroke centers in anterior and posterior circulation

BACKGROUND AND PURPOSE The DRAGON score predicts functional outcome in the hyperacute phase of intravenous thrombolysis treatment of ischemic stroke patients. We aimed to validate the score in a large multicenter cohort in anterior and posterior circulation. METHODS Prospectively collected data of consecutive ischemic stroke patients who received intravenous thrombolysis in 12 stroke centers were merged (n=5471). We excluded patients lacking data necessary to calculate the score and patients with missing 3-month modified Rankin scale scores. The final cohort comprised 4519 eligible patients. We assessed the performance of the DRAGON score with area under the receiver operating characteristic curve in the whole cohort for both good (modified Rankin scale score, 0-2) and miserable (modified Rankin scale score, 5-6) outcomes. RESULTS Area under the receiver operating characteristic curve was 0.84 (0.82-0.85) for miserable outcome and 0.82 (0.80-0.83) for good outcome. Proportions of patients with good outcome were 96%, 93%, 78%, and 0% for 0 to 1, 2, 3, and 8 to 10 score points, respectively. Proportions of patients with miserable outcome were 0%, 2%, 4%, 89%, and 97% for 0 to 1, 2, 3, 8, and 9 to 10 points, respectively. When tested separately for anterior and posterior circulation, there was no difference in performance (P=0.55); areas under the receiver operating characteristic curve were 0.84 (0.83-0.86) and 0.82 (0.78-0.87), respectively. No sex-related difference in performance was observed (P=0.25). CONCLUSIONS The DRAGON score showed very good performance in the large merged cohort in both anterior and posterior circulation strokes. The DRAGON score provides rapid estimation of patient prognosis and supports clinical decision-making in the hyperacute phase of stroke care (eg, when invasive add-on strategies are considered).

The Legal Character of Sino-African Tied Aid: Cunning Fox or Wise Dragon?

Paper presented by Charlotte Sieber-Gasser at the African IEL Network Conference, 5th-6th of May 2011, The Mandela Institute, Johannesburg (South Africa) Sino-African trade has seen a fifty-fold increase in the years 1999 to 2008. China became the second most important trading partner for the African economy and already overtook the US as the most important trading partner in some African regions. However, all of this trade is taking place independent from legal regulation by a preferential or other trade agreement. Interestingly, Sino-African trade has seen particular increase in countries that have agreed to tied aid arrangements with China. Taking a closer look at these tied aid arrangements (the so-called Angola-Model) reveals, that some aspects might indeed have a positive effect on Sino-African trade in general. Several grey areas might potentially conflict with WTO-law. However, tied aid is excluded from the GATS, the GATT, and the GPA – in other words, it is outside the sphere of WTO-law. The paper analyses three critical aspects of the Angola-Model version of tied aid with reference to WTO-law, and elaborates the importance of regulating trade-distorting aspects of modern tied aid.