Modified SOAR Score for Stroke

• The mSOAR Score may be considered in patients with acute stroke, as a predictor of short-term mortality.
• The score should not be used as a substitute for clinical judgment, or as a sole predictive tool for mortality.

Acute ischemic stroke and intracerebral hemorrhage (ICH) are both neurological emergencies. Patients with acute ischemic stroke, in particular, can benefit from time-sensitive treatments (e.g. tPA, mechanical thrombectomy) that can be administered if certain clinical conditions are met.

In cases of suspected acute ischemic stroke, the following is recommended:

• STAT neurological consultation.
• STAT CT head without contrast.
• STAT laboratory testing (CBC, PT/INR/aPTT, basic metabolic panel, type & screen, troponin-I).
• Consider STAT CT angiogram of the head & neck in cases of suspected acute stroke due to large-vessel occlusion (LVO).

In cases of confirmed acute intracerebral hemorrhage, the following is recommended:

• Airway, breathing and circulation monitoring.
• Immediate neurological and neurosurgical consultation.
• Thorough medication history to identify anticoagulant and antiplatelet-associated hemorrhage.
• Hypertensive patients with ICH should undergo blood pressure reduction with intravenous agents. The target blood pressure should be discussed with neurological or neurosurgical consultants if available.
• Similarly, the decision to administer reversal agents (e.g. desmopressin, vitamin K), blood products (e.g. prothrombin complex concentrates, fresh frozen plasma), or anti-epileptic medications should not be made without discussion with the neurological or neurosurgical consultant if available.

It is crucial to identify anticoagulant-associated ICH with careful medication history, and reverse with agents specifically tailored to the offending anticoagulant. 

Platelet transfusion is not recommended in cases of spontaneous antiplatelet-related ICH.