For healthcare professionals
DRAGON Score for Ischemic Stroke Treated with IV Thrombolysis
The DRAGON score adds points for six findings available before intravenous thrombolysis for acute ischemic stroke: CT signs, prestroke disability, age, glucose, onset-to-treatment time and stroke severity on the NIH Stroke Scale (NIHSS). The total runs from 0 to 10, and it was built to predict the outcome at 3 months. This tool is written for clinicians. It is not a self-check and not a diagnosis.
The six items
Levels and points as printed by Drozdowska and colleagues (Drozdowska 2019). The short notes are our own. Nothing you enter leaves this page.
What you will see
The DRAGON score from 0 to 10 and the points from each item.
Educational only, not medical advice. A score supports clinical judgment; it does not decide treatment on its own.
Source
Strbian D et al., Neurology 2012 (the original score, cited only). Levels and points as printed in Drozdowska BA et al., Front Neurol 2019 (CC BY 4.0), with the five clinical items and their points also printed in Turc G et al., PLoS One 2014 (CC BY 4.0).
Validated in
Derived in a single-center cohort in Finland, 1995 to September 2010, with basilar artery occlusions excluded; 1,319 patients were used for model derivation (Drozdowska 2019). For use in adults with acute ischemic stroke treated with IV thrombolysis.
Limits
For clinicians, not a diagnosis. Built for patients given IV thrombolysis; it does not decide who should get thrombolysis or thrombectomy. Outcome rates for each single score are not shown here; see the original paper. A 2026 critical care guideline suggests the score not be considered a reliable predictor of poor outcome at 3 months or later. Use it with, not instead of, clinical judgment.
How the score works
The DRAGON score includes a dense cerebral artery or early infarct signs on computed tomography, prestroke modified Rankin Scale (mRS) score, age, baseline glucose level, onset to treatment time and baseline NIHSS (Mainali 2026). The points for each level are set out below (Drozdowska 2019). The same points for prestroke mRS, age, glucose, onset-to-treatment time and NIHSS are printed in a study of the MRI version of the score, which has a range of 0 to 10 points (Turc 2014). The score was first described by Strbian and colleagues (Strbian 2012).
| Item | Level | Points |
|---|---|---|
| Hyperdense cerebral artery or early infarct signs on CT scan | None | 0 |
| Either | 1 | |
| Both | 2 | |
| Prestroke mRS | 1 or less | 0 |
| Over 1 | 1 | |
| Age | Under 65 years | 0 |
| 65 to 79 years | 1 | |
| Over 79 years | 2 | |
| Glucose | 8 mmol/L or less | 0 |
| Over 8 mmol/L | 1 | |
| Onset-to-treatment time | 90 minutes or less | 0 |
| Over 90 minutes | 1 | |
| Baseline NIHSS | 0 to 4 | 0 |
| 5 to 9 | 1 | |
| 10 to 15 | 2 | |
| Over 15 | 3 |
What the score predicts
The DRAGON score predicts an outcome in three groups based on the mRS: good (mRS 0 to 2), poor (mRS 3 to 4) and miserable (mRS 5 to 6) (Mainali 2026). In the derivation study, at 3 months, 798 patients (60%) had mRS 0 to 2, 339 (26%) had mRS 3 to 4 and 182 (14%) had mRS 5 to 6 (Drozdowska 2019). The original paper reports the outcome for each score (Strbian 2012). We do not show those figures, because we could not find them printed in an open source.
How well it performed
On internal validation, the DRAGON score had an AUROC of 0.84 (95% CI 0.80 to 0.87) for prediction of miserable outcome (Drozdowska 2019). In one study that used the CT-DRAGON score to predict the 90-day outcome in 427 patients, its AUROC was 0.78 (95% CI 0.74 to 0.81) for favorable and 0.78 (95% CI 0.72 to 0.83) for miserable outcome (Lesenne 2020). A 2026 guideline for critically ill adults with acute ischemic stroke suggests that the DRAGON, MR-DRAGON and MT-DRAGON scores not be considered reliable predictors of poor functional outcome at 3 months or later (weak recommendation; very low quality evidence) (Mainali 2026). Results from these cohorts may not carry over to other settings.
Related calculators
For a 0 to 9 outcome score from age, NIHSS and three chronic diseases, see the THRIVE score. For the risk of symptomatic intracranial hemorrhage after IV thrombolysis, see the SEDAN score. For a 3-month outcome score from age, NIHSS and four other admission findings, see the ASTRAL score. For a quick age plus NIHSS index, see the SPAN-100 index. To score stroke severity, see the NIH Stroke Scale calculator. To grade disability before and after a stroke, see the modified Rankin Scale. Other bedside scores are listed under For healthcare professionals.
Sources
- Strbian D, Meretoja A, Ahlhelm FJ, Pitkäniemi J, Lyrer P, Kaste M, Engelter S, Tatlisumak T. Predicting outcome of IV thrombolysis-treated ischemic stroke patients: the DRAGON score. Neurology. 2012;78(6):427-432. doi:10.1212/WNL.0b013e318245d2a9. PMID 22311929. Original score (cited only). doi.org/10.1212/WNL.0b013e318245d2a9
- Drozdowska BA, Singh S, Quinn TJ. Thinking About the Future: A Review of Prognostic Scales Used in Acute Stroke. Front Neurol. 2019;10:274. doi:10.3389/fneur.2019.00274. PMID 30949127. Open access (CC BY 4.0). Table 4: DRAGON variables, levels and points; Tables 1 and 2: derivation cohort (Finland, single-center, 1995 to Sep 2010, 1,319 patients; 3-month mRS 0-2 798 (60%), 3-4 339 (26%), 5-6 182 (14%)); text: internal validation AUROC 0.84 (95% CI 0.80-0.87) for miserable outcome. pmc.ncbi.nlm.nih.gov/articles/PMC6437031/
- Turc G, Aguettaz P, Ponchelle-Dequatre N, Hénon H, Naggara O, Leclerc X, Cordonnier C, Leys D, Mas JL, Oppenheim C. External validation of the MRI-DRAGON score: early prediction of stroke outcome after intravenous thrombolysis. PLoS One. 2014;9(6):e99164. doi:10.1371/journal.pone.0099164. PMID 24896827. Open access (CC BY 4.0). Table 1: MRI-DRAGON score (0-10 points), with prestroke mRS, age, glucose, onset-to-treatment time and NIHSS points. pmc.ncbi.nlm.nih.gov/articles/PMC4045936/
- Mainali S, Fontaine GV, Rajajee V, Montellano FA, Muehlschlegel S, Wartenberg KE, et al. Guidelines for Neuroprognostication in Critically ill Adults with Acute Ischemic Stroke. Neurocrit Care. 2026;44(3):745-769. doi:10.1007/s12028-026-02486-3. PMID 41942818. Open access (CC BY 4.0). DRAGON variables and trichotomized mRS outcome; recommendation 11: DRAGON, MR-DRAGON and MT-DRAGON not to be considered reliable predictors of poor functional outcome at 3 months or later (weak recommendation; very low quality evidence). pmc.ncbi.nlm.nih.gov/articles/PMC13249629/
- Lesenne A, Grieten J, Ernon L, Wibail A, Stockx L, Wouters PF, Dreesen L, Vandermeulen E, Van Boxstael S, Vanelderen P, et al. Prediction of Functional Outcome After Acute Ischemic Stroke: Comparison of the CT-DRAGON Score and a Reduced Features Set. Front Neurol. 2020;11:718. doi:10.3389/fneur.2020.00718. PMID 32849196. Open access (CC BY 4.0). Abstract: CT-DRAGON AUROC 0.78 (95% CI 0.74-0.81) for favorable and 0.78 (95% CI 0.72-0.83) for miserable outcome at 90 days in 427 patients. pmc.ncbi.nlm.nih.gov/articles/PMC7412791/
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