Abstract
Background: Stroke is one of the leading cause of premature death globally. Early identification of ischaemic stroke is crucial. Neuro-Imaging techniques have been indispensable to distinguish between these Ischaemic and haemorrhagic stroke but infrequently available in rural areas. To overcome these difficulties and to enhance clinical bedside diagnosis, clinical scores have been developed. The most commonly used ones include Besson score (BS), Greek score (GS) and Siriraj score (SS). We aimed to identify the best among these scores
Methods: A cross sectional study was conducted on patients with stroke admitted in KLES Dr Prabhakar Kore Hospital and Medical Research Centre, Belagavi from Jan 2016 to Dec 2016.The diagnosis of stroke was entertained after fulfilling WHO definition of stroke by the patient. They were then scored according to the scoring systems and validity tests of these scores were obtained by comparing it with neuroimaging.
Results: 61 patients (42 patients (68.85%) ischemic stroke and 19 patients (31.15%) hemorrhagic stroke) were included in our study. For hemorrhagic stroke GS had the highest specificity (97.62%) while SS had the highest sensitivity (78.95%). For ischemic stroke BS had the highest specificity (94.74%) while SS had the highest sensitivity (80.95%). SS was better tool in identifying stroke type in our study [AUC (0.902)].
Conclusion: We found SS was a better scoring system for both types of strokes although all have certain limitations. Hence we feel neuroimaging is the still the best in differentiating the type of stroke.
Keywords: Besson score, Greek score, Siriraj score, stroke.
References
- Goldstein M, Barnett HJM, Orgogozo JM, Sartorius N. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke 1989;20: 1407-31.
- WHO: World Health Statistics 2014
- http://www.sancd.org/Updated%20Stroke%20Fact%20sheet %202012.pdf: stroke fact sheet India
- Prasad K, Singhal KK. Stroke in young: An Indian perspective. Neurol India 2010;58: 343-50
- Anand K, Chowdhury D, Singh KB, Pandav CS, Kapoor SK.Estimation of mortality and morbidity due to strokes in India. Neuroepidemiology 2001;20(3): 208-11.
- Bonita R, Beaglehole R. Stroke prevention in poor countries. Time for action. Stroke 2007;38:2871-2872.
- Pandian JD, Srikanth V, Read SJ, Thrift AG. Poverty and stroke in India. A time to act. Stroke 2007;38:3063-3069.
- Hariklia VD, Apostolos H, HaralamboskThe Role of Uric Acid in Stroke. The lssue Remains Unresolved. The Neurologist 2008;14:238-42.
- Allen CM. Clinical diagnosis of the acute stroke syndrome. Q J Med. 1983;52:515–23.
- Besson G, Robert C, Hommel M, Perret J. Is it clinically possible to distinguish nonhemorrhagic infarct from hemorrhagic stroke? Stroke. 1995;26:1205–9.
- Efstathiou SP, Tsioulos DI, Zacharos ID, Tsiakou AG, Mitromaras AG, Mastorantonakis SE, et al. A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke. J Intern Med. 2002;252:121–9.
- Poungvarin N, Viriyavejakul A, Komontri C. Siriraj stroke score and validation study to distinguishsupratentorial intracerebral haemorrhage from infarction. BMJ. 1991;302:1565–7
- Soman A, Joshi SR, Tarvade S, Jayaram S. Greek stroke score, Siriraj score and Allen score in clinical diagnosis of intracerebral hemorrhage and infarct: Validation and comparison study.Indian J Med Sci 2004;58:417‑22
- Goswami RP, Karmakar PS, Ghosh A. Bedside utility of clinical scoring systems in classifying stroke. Indian J Med Sci 2013;67:137-45
- Nouira S, Boukef R, Bouida W, Marghli S, Dridi Z, Benamou S, et al. Accuracy of two scores in the diagnosis of stroke subtype in a multicenter cohort study. Ann Emerg Med 2009;53:373‑8.
Corresponding Author
Dr Anish J. Kuriakose
Department of Medicine, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
Phone (or Mobile) No.: +91-9048477879/ +91-7899097701, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.