This study investigates the prognostic ability of the Orpington Prognostic Scale 
within 48 hours (OPS-1) after admission in predicting outcome at 6 months and 2 
years in acute ischemic stroke and compares it with the 2 week OPS (OPS-2). All 
consecutive ischemic stroke patients (n = 117) were scored on the OPS, Barthel 
activities of daily living, Oxford handicap scale, European stroke scale, and 
Rivermead motor assessment at 48 hours, 2 weeks, 6 months, and 2 years 
post-stroke. Baseline OPS scores at 48 hours and 2 weeks were used to predict 
outcomes at 6 months and 2 years. The OPS-1 was an excellent predictor of length 
of hospital stay (P < .001), place of discharge (P < .01), and outcome at 6 
months and 2 years (P < .0001, Fisher's exact). The OPS-2 was marginally better 
than the OPS-1 though this benefit was outweighed by the earlier stratification 
of the 48-hour measure. The sensitivity, specificity, and positive predictive 
values (PPV) of the "good" OPS-1 versus the OPS-2 at predicting independence at 
6 months were 85% vs 92%, 85% vs 63% and 87% vs 92%, respectively. The 
sensitivity, specificity, and PPV of the "poor" OPS-1 versus OPS-2 were 48% v 
35%, 97% v 100%, and 93% v 100% respectively. The OPS at 48 hours is a good 
predictor of outcome at 6 months and 2 years after ischemic stroke and allows 
early identification of 3 prognostic groups, which may help in identifying 
patients most likely to benefit from intensive rehabilitation.