For healthcare professionals
Stroke Prognosis Instrument II (SPI-II)
The Stroke Prognosis Instrument II adds up seven weighted items in a patient who has had a TIA or an ischemic stroke, for a total from 0 to 15, and sorts the patient into a low, moderate or high risk group for a further stroke. This calculator is written for clinicians planning secondary prevention and is not a diagnosis.
The seven items
Items and points as printed in Table 1 of Kongwatcharapong and colleagues (Kongwatcharapong 2023) and in the Methods of Xiong and colleagues (Xiong 2023). Nothing you enter leaves this page.
What you will see
The total from 0 to 15, the items present, and the low (0 to 3), moderate (4 to 7) or high (8 to 15) risk group.
Educational only, not medical advice. Not a diagnosis. Treatment decisions belong to the treating team.
Source
Items, points and the 0 to 3, 4 to 7 and 8 to 15 groups as printed in Table 1 of Kongwatcharapong J and colleagues, BMC Neurology 2023 (open access, CC BY 4.0), and in the Methods of Xiong Y and colleagues, Brain and Behavior 2023 (open access, CC BY 4.0). Original score: Kernan WN and colleagues, Stroke 2000 (cited only). Licences were checked in the Europe PMC full text. The tests check every item, both ends of the range and each group boundary.
Validated in
Kongwatcharapong 2023: 543 patients after acute ischemic stroke at one hospital in Bangkok, Thailand, 2014 to 2018, followed for three years. Xiong 2023: 50,374 patients with acute ischemic stroke or TIA in three China National Stroke Registries, followed for one year. For the cohorts the score was built and first tested in, see Kernan 2000.
Limits
Both open studies found only moderate or limited accuracy: an area under the curve of 0.646 in Thailand and 0.60 in China, with a decline over 13 years (Kongwatcharapong 2023, Xiong 2023). It is not a score for atrial fibrillation; for that, see CHA2DS2-VASc. It does not replace a full stroke work-up.
Points table
| Item | Points |
|---|---|
| Age over 70 years | 2 |
| Diabetes mellitus | 3 |
| Hypertension | 1 |
| Coronary artery disease | 1 |
| Index event was a stroke, not a TIA | 2 |
| Congestive heart failure | 3 |
| Prior stroke (prior cerebral infarction, not prior TIA) | 3 |
| Total | 0 to 15 |
Source: Table 1 of Kongwatcharapong and colleagues 2023 (Kongwatcharapong 2023), and the seven factors as written out by Xiong and colleagues 2023 (Xiong 2023). Two notes from Table 1 apply. Prior stroke means a prior cerebral infarction, not a prior TIA. Coronary artery disease scores one point in total, so a patient with a past myocardial infarction who now has angina scores one point on the SPI-II, not two (Kongwatcharapong 2023). Table 1 lists ages 70 to 75 and over 75 at 2 points each, and ages under 65 and 65 to 70 at 0 points; Xiong and colleagues write the item as age over 70 years (Xiong 2023). The score was first described by Kernan and colleagues in 2000 (Kernan 2000).
Risk groups
| SPI-II score | Risk group |
|---|---|
| 0 to 3 | Low |
| 4 to 7 | Moderate |
| 8 to 15 | High |
Groups as printed in Table 1 of Kongwatcharapong and colleagues (Kongwatcharapong 2023). Xiong and colleagues give the same cut points for the low, medium and high risk groups, citing Kernan 2000 (Xiong 2023).
Worked example: a 72-year-old (+2) with diabetes (+3) whose index event was a stroke (+2) and who has no other listed item scores 7, in the moderate risk group.
What studies found
In 543 Thai patients followed for three years after an ischemic stroke, 181 had a further stroke. Of those, 134 (74.03%) had been in the SPI-II high risk group. The area under the curve was 0.646 (95% CI, 0.594 to 0.697), and the authors judged the predictive performance moderate (Kongwatcharapong 2023).
In 50,374 patients with ischemic stroke or TIA in three Chinese national registries, 10.7% had a further stroke within one year. The area under the curve for the SPI-II was 0.60, from 0.60 in the first two registries to 0.58 in the third. The authors concluded the score may not be useful for current practice (Xiong 2023).
Related calculators
For a 0 to 9 score built on similar risk factors, see the Essen Stroke Risk Score. For early stroke risk in the days after a TIA, see the ABCD2 score. For a plain-language check of stroke risk factors with a CHA2DS2-VASc explainer for atrial fibrillation, see the stroke risk factor check. Other bedside scores are listed under For healthcare professionals.
Sources
- Kongwatcharapong J, Sornkhamphan A, Kaveeta C, Nathisuwan S. Validation and comparison of the stroke prognosis instrument (SPI-II) and the essen stroke risk score (ESRS) in predicting stroke recurrence in Asian population. BMC Neurol. 2023;23(1):287. doi:10.1186/s12883-023-03329-w. PMID 37528418. Open access (CC BY 4.0). Table 1 and footnotes: SPI-II items, points, total 15, low 0 to 3, moderate 4 to 7, high 8 to 15; abstract: 543 patients, 134 (74.03%) of 181 recurrences high risk, AUROC 0.646. pmc.ncbi.nlm.nih.gov/articles/PMC10391888/
- Xiong Y, Wang S, Li Z, Fisher M, Wang L, Jiang Y, Huang X, Zhao XQ, Meng X, Wang Y. Thirteen-year trends in risk scores predictive values for subsequent stroke in patients with acute ischemic event. Brain Behav. 2023;13(5):e2962. doi:10.1002/brb3.2962. PMID 36978218. Open access (CC BY 4.0). Methods: SPI-II seven factors and points, groups 0 to 3, 4 to 7 and 8 to 15; results: 50,374 patients in CNSR-I to III, AUC 0.60. pmc.ncbi.nlm.nih.gov/articles/PMC10176011/
- Kernan WN, Viscoli CM, Brass LM, Makuch RW, Sarrel PM, Roberts RS, Gent M, Rothwell P, Sacco RL, Liu RC, Boden-Albala B, Horwitz RI. The stroke prognosis instrument II (SPI-II): a clinical prediction instrument for patients with transient ischemia and nondisabling ischemic stroke. Stroke. 2000;31(2):456-462. doi:10.1161/01.str.31.2.456. PMID 10657422. Original score (cited only; not open access). doi.org/10.1161/01.str.31.2.456
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