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Background: Currently there is no predictive model in acute minor stroke without large vessel occlusion.

Aims: Our objective was to evaluate the independent predictors that correlate with unfavourable outcome and to develop a predictive scale in acute setting.

Methods: Retrospective analysis of consecutive acute minor stroke (NIHSS <5) admitted within 4.5 hours to clinical onset who were previously not disabled and without large vessel occlusion on CT angiography (intracranial or extracranial occlusion or stenosis ≥50%). Unfavourable outcome was defined as modified Rankin Scale 3-6 at 90 days. Independent predictors of disability were included in the model.

Results: A total of 408 patients with acute minor stroke (NIHSS <5) were analyzed. Large vessel occlusion was detected in 83 (20%), who were excluded. The final analysis included 325 patients, with mean age of 68± 14 years, 59% were men and 14.5% had unfavourable outcome. On multivariate analysis, age >70 years, NIHSS >2, recurrent event, posterior circulation ischemia and previous stroke were associated with unfavourable outcome. Recurrent event was excluded to the model because this variable is not available in acute setting. With the variables detected in the logistic regression, a predictive model was made (SPAN₂ scale: previous Stroke, Posterior ischemia, Age >70 or NIHSS >2). The model correctly classified 84% of the patients with unfavourable outcome. A score >2 points on the SPAN₂ scale showed a sensitivity 95%, specificity 51%, PPV 25% and NPV 99% of unfavourable outcome at 90 days.

Conclusions: SPAN₂ scale could be useful to stratify the risk of unfavourable outcome in acute phase of minor stroke without large vessel occlusion. Future studies may validate its usefulness in the selection of patients for thrombolytic therapy.