RoPE score: the risk of paradoxical embolism index (Kent 2013)
The RoPE score (Risk of Paradoxical Embolism) is a 0 to 10 points index for people with a cryptogenic stroke and a patent foramen ovale (PFO). Younger age and the absence of common vascular risk factors push the score up, as does a cortical infarct on imaging. This RoPE calculator adds the points from Kent 2013 and reports which of the paper's score ranges the total falls in.
Not a medical device. Not a diagnosis or dosing recommendation.
What is the RoPE score?
When a stroke has no clear cause and a PFO is found, the PFO may be involved or may be a bystander. Kent and colleagues built the RoPE index to estimate how likely it is that the PFO is related to the stroke rather than incidental. A higher score points towards a stroke-related PFO.
The calculator doesn't read imaging or medical histories. Every factor is supplied by the caller.
The RoPE score formula
RoPE = age points
+ 1 if no hypertension
+ 1 if no diabetes
+ 1 if no prior stroke or TIA
+ 1 if nonsmoker
+ 1 if cortical infarct on imaging
age: 18-29 5, 30-39 4, 40-49 3, 50-59 2, 60-69 1, 70 or older 0
total 0 to 10Exact expression the calculator uses:
ROPE = age_points + no_hypertension 1 + no_diabetes 1 + no_prior_stroke_tia 1 + nonsmoker 1 + cortical_infarct 1; age 18-29 5, 30-39 4, 40-49 3, 50-59 2, 60-69 1, >=70 0; Kent 2013 Table 4; max 10Inputs
| Input | Meaning | Points |
|---|---|---|
age | Age in years, 18 to 120 | 0 to 5 by decade |
no_hypertension | No history of hypertension | 1 if true |
no_diabetes | No history of diabetes | 1 if true |
no_prior_stroke_tia | No earlier stroke or TIA | 1 if true |
nonsmoker | Not a smoker | 1 if true |
cortical_infarct | A cortical infarct on imaging | 1 if true |
The four history factors score for the absence of a risk factor, which is why someone with none of them scores higher.
How the calculation works
- Score age by decade: 18 to 29 is 5, 30 to 39 is 4, 40 to 49 is 3, 50 to 59 is 2, 60 to 69 is 1 and 70 or older is 0.
- Add 1 for each true factor among the five yes/no inputs.
- Report the range the total falls in:
| Total | rope_stratum |
|---|---|
| 0 to 3 | 0_to_3 |
| 4 to 8 | 4_to_8 |
| 9 to 10 | 9_to_10 |
Kent 2013 described the 0 to 3 and 9 to 10 ranges in its abstract. The middle range is just the scores left over and isn't a class the paper named.
Worked examples
These use Magent's own expected values for the calculator.
Example 1: age 25 with all five factors
- Age 25 scores 5.
- No hypertension, no diabetes, no prior stroke or TIA, nonsmoker and cortical infarct: 1 + 1 + 1 + 1 + 1 = 5.
- 5 + 5 = 10.
- RoPE 10, range
9_to_10.
Example 2: age 45 with none of the factors
- Age 45 scores 3.
- No factor is true, so nothing is added.
- RoPE 3, range
0_to_3.
Example 3: age 25 with none of the factors
- Age 25 scores 5.
- No factor is true.
- RoPE 5, range
4_to_8.
History of the RoPE score
Kent and colleagues published "An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke" in Neurology in 2013. The point values the calculator uses are from Table 4 of that paper.
When it's used
When a PFO has been found after a stroke without a clear cause and the team wants a structured estimate of how likely the two are related.
Where it's used
Stroke units, neurology and cardiology clinics, and research on PFO.
Who uses it
Neurologists, cardiologists and stroke teams. The calculator adds the points.
Limits of the calculation
- It applies to cryptogenic stroke with a PFO, not to other strokes.
- The factors are taken as given; the calculator doesn't check imaging or histories.
- A score isn't a finding that the PFO caused the stroke, and the calculator gives no advice about PFO closure.
- It isn't the PASCAL classification.
- This page doesn't say what a score means for a particular person.
Clinical decisions belong to a qualified clinician who knows the patient.
How it differs from related calculators
- ABCD2 score grades short-term stroke risk after a TIA; it says nothing about a PFO.
Glossary
- PFO: patent foramen ovale, a small opening between the upper chambers of the heart.
- Paradoxical embolism: a clot that crosses from the venous to the arterial side through such an opening.
- Cryptogenic stroke: a stroke with no cause found after assessment.
- Cortical infarct: an area of stroke damage involving the brain's outer layer.
Common mistakes
- Scoring the risk factors themselves. Points go to their absence: no hypertension, no diabetes, no prior stroke or TIA, nonsmoker.
- Giving points for age 70 or older. That band scores 0.
- Treating 4 to 8 as a named class. It's the range between the two the paper described.
Source
Kent DM, et al. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013;81(7):619-625. DOI: 10.1212/WNL.0b013e3182a08d59. PMID: 23864310
Frequently asked questions
How is the RoPE score calculated?
Add age points (5 for 18 to 29, falling by 1 per decade to 0 at 70 or older) to 1 point each for no hypertension, no diabetes, no prior stroke or TIA, being a nonsmoker and a cortical infarct.
What is the maximum RoPE score?
10.
Is a high RoPE score a reason to close a PFO?
The calculator doesn't say. It reports the points and the score range, nothing more.
Why does a younger person score higher?
The Table 4 age points fall by one per decade, so younger ages carry more points.