Title: Prospective Study of Importance of Clinical Scores in the Differentiation of Stroke Subtypes
Authors: Dr Muddada Yugandhar, Dr Balakrishna GT, Dr Gagan Behara, Dr Sarma VSN Rachakonda
DOI: https://dx.doi.org/10.18535/jmscr/v7i12.109
Abstract
Introduction
Stroke is defined as “rapidly developing clinical symptoms and/ or signs of focal and at times global (applied to patients in deep coma and to those with subarachnoid hemorrhage) loss of cerebral function with symptoms lasting for more than 24 hours or leading to death, with no apparent cause other than that of vascular origin”1.
Community based surveys from different region of the country show a crude prevalence rate of strokes presumed to be of vascular origin in the range of 200 per 100000 population2 .Stroke is the second leading cause of death worldwide, causing 6.2 million deaths in 2011, and is double the rate of heart disease in China. The most important step in the management of acute stroke is differentiating whether the stroke is Ischemic or Hemorrhagic in nature as the management for both is significantly different and management of one subtype is often contraindicated in the other subtype. The most accurate investigation to differentiate between the ischemic or hemorrhagic stroke is Computed Tomography. But the availability of a CT scan in developing countries is limited and whenever available many patients could not be able to afford it. This makes the primary care physicians in acute stroke units resort to clinical features to differentiate between the subtypes. In order to achieve this various clinical score were developed.
In order to help the primary care physicians to effectively differentiate between the stroke subtypes, in 1984, the Guy’s Hospital score was developed as a clinical diagnostic tool for intracranial hemorrhage. The calculations involved in Guy’s scoring system were too complex for bedside application. Later in 1986, another simpler scoring system was evolved at the Siriraj hospital of Thailand has found greater acceptance. Till such time these scoring system have been fully evaluated and endorsed it is necessary to test them against the gold standard of CT scanning. This study attempts to test the utility of the Guy’s Hospital score and Siriraj stroke score in the diagnosis of acute stroke.
References
- Hatano S. Experience from a multicentre stroke register: a preliminary report. Bulletin of the World Health Organization. 1976;54(5):541.
- Dalal PM. Neurology, India 1997; 45: 127-131.
- Mwita C, Kajia D, Gwer S, Etyang A, Newton C. Clinical stroke scores for distinguishing stroke subtypes: a systematic review of diagnostic test accuracy. JBI Database of Systematic Reviews and Implementation Reports. 2013 Mar 1;11(3):191-226.
- Pavan Manibettu Raghuram, Mallanagouda Shivanagouda Biradar, Jayakumar Jeganathan. Comparison of the Siriraj stroke Score and the Guy’s Hospital Score in South India. Journal of Clinical and Diagnostic Research. 2012 June, Vol-6(5): 851-854.
- Hawkins GC, Bonita R, Broad JB, Anderson NE. Inadequacy of clinical scoring systems to differentiate stroke subtypes in population-based studies. Stroke. 1995 Aug 1;26(8):1338-42.
- Kochar DK, et al. Poor diagnostic accuracy and applicability of Siriraj stroke score, Allen score and their combination in differentiating acute haemorrhagic and thrombotic stroke. The Journal of the Association of Physicians of India. 2000 Jun;48(6):584-8.