Poor accuracy of the Siriraj and Guy's hospital stroke scores in distinguishing haemorrhagic from ischaemic stroke in a rural, tertiary care hospital.

BACKGROUND: In India stroke is associated with a high morbidity and mortality. Bedside clinical examination does not always help in distinguishing cerebral infarction from intracranial haemorrhage. We evaluated the accuracy of the Guy's hospital and Siriraj stroke scores in distinguishing haemorrhagic from ischaemic stroke in a rural setting. METHODS: Patients with suspected stroke admitted to a rural teaching hospital were prospectively enrolled. Two investigators collected data for computing the Guy's hospital and Siriraj scores. Cut-off points, as described by the authors of the original scores, were used to predict haemorrhage and infarction. The scores were compared in a blind and independent manner with the computed tomography (CT) scan. The sensitivity, specificity, positive and negative likelihood ratios and agreement between the two scores were calculated. RESULTS: Of the 259 patients admitted for suspected stroke, 134 patients (73 men) underwent both clinical evaluation and a CT scan. The Siriraj score discriminated haemorrhage from infarction with a sensitivity of 78.5% (95% CI: 66.5, 87.7) and specificity of 71% (95% CI: 52, 85.8). The likelihood ratio of a positive test was 2.7 (95% CI: 1.54, 4.75) and that of a negative test was 0.3 (95% CI: 0.17, 0.53). For the Guy's hospital score the sensitivity was 81% (95% CI: 68.6, 90.1), specificity 76.2% (95% CI: 52.8, 91.8), likelihood ratio of a positive test 3.4 (95% CI: 1.57, 7.39) and that of a negative test 0.25 (95% CI: 0.11, 0.54). Both scores, when combined, were 80% sensitive (95% CI: 66.3, 90) and 80% specific (95% CI: 51.9, 95.7). The agreement between the two scores was modest (kappa = 0.51), but very good (kappa = 0.93) after exclusion of equivocal score results. CONCLUSION: Our study suggests that neither of the stroke scores is sufficiently accurate for distinguishing the type of stroke. CT scan, and not history and clinical signs, can accurately identify haemorrhage from infarction in acute stroke.

Comparison of Siriraj and Guy's Hospital score to differentiate supratentorial ischaemic and haemorrhagic strokes in the Indian population.

In India, 70% of the population does not have access to computerised brain scanning. Siriraj score is a safe and reliable clinical method to asses acute stroke syndrome. 160 patients with acute stroke were analysed by Siriraj and Guy's hospital stroke score simultaneously. CT Scan was performed in all and subarachnoid haemorrhage was excluded. Ninety two patients (57.5%) had infarction and 68 (42.5%) had haemorrhage. Siriraj score formula revealed haemorrhage in 53 (80%) and infarction in 78 (83%), while in the rest the results were equivocal or incorrect. Guy's hospital score revealed haemorrhage in 45 (66%) and infarction in 59 (69%). Clinical features are also helpful in differentiating infarction from haemorrhage, but the accuracy is not as high as with Siriraj score and secondly Siriraj score is a very simple formula in comparison to Guy's score.