Abstract DP015: Integrating Systemic and Socio-economic Factors Into Stroke Prognostic Models: Findings From the ELAN International Survey

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Prognosis after acute stroke varies widely and is usually guided by imaging and clinical markers. Factors such as frailty, cognition, comorbidities, mental health, social support, and financial status strongly influence recovery but are rarely considered. To address this gap, we developed the ELAN Score, a structured 10-point tool across six domains: cognition, pre-existing disability/frailty, comorbidities, mental health, social support and financial factors. Using a global survey, we aimed to evaluate associations between individual ELAN domains and clinicians’ prediction of recovery and coping potential after a stroke. In an international online survey, stroke neurologists, neurointerventionalists, and allied specialists were randomly assigned 30 of 324 case vignettes. Each vignette described a patient with large vessel occlusion, good ASPECTS who achieved TICI 3 reperfusion, and systematically varied the severity of ELAN-specific domains. Participants were blinded to the ELAN score; scores were calculated in the background using pre-specified domain weights. Respondents were asked to estimate: the probability of return to pre-stroke functional status, and the probability of coping with an unfavorable outcome. Associations between ELAN score, individual domains, and perceived outcomes were examined using mixed-effects Poisson regression adjusted for clinician demographics, specialty, and country, with participant ID as random effect. Forty-eight participants (33% stroke neurologists, 37% interventionists; 78% >10 years’ experience; 37% women) from 18 countries completed the survey. Higher ELAN scores were significantly associated with lower probability of both respondent-predicted functional recovery and coping potential (adjIRR 0.93, 95% CI 0.91–0.95 and 0.91, 95% CI 0.90–0.93, respectively, Figure 1). In multivariable models, cognitive impairment, pre-existing disability, multiple comorbidities, and limited financial resources were consistently perceived as predictors of poor recovery, while cognition, disability, and finances were key for coping potential (Tables 1–2). Mental health and social support were not perceived as independent predictors. Clinicians in this international vignette-based survey recognized cognition, disability, and financial status as key determinants of outcome. Future work should test ELAN prospectively in diverse healthcare systems and evaluate whether structured incorporation of these factors improves prognostic accuracy.

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