Siriraj stroke score and validation study to distinguish supratentorial intracerebral haemorrhage from infarction.
OBJECTIVE
To develop a simple, reliable, and safe diagnostic tool for acute stroke syndromes in a setting where computerised brain scanning was not readily available and to validate its accuracy with regard to pathological types of stroke.


METHODS
13 clinical variables that potentially might differentiate supratentorial cerebral haemorrhage from infarction were recorded and tested by multivariate analysis in a prospective study of 174 patients with acute stroke. In developing the Siriraj stroke score stepwise discriminant analysis of the variables was followed by a linear discriminant equation to differentiate between supratentorial haemorrhage and infarction. The score obtained was validated against scores in 206 other patients with stroke, computerised brain scans being used for definitive diagnosis.


METHODS
Siriraj Hospital Medical School, Mahidol University, Bangkok.


METHODS
Prospective study: 174 consecutive patients with acute supratentorial stroke syndrome (not subarachnoid haemorrhage) admitted to Siriraj Hospital during 1984-5; validation study: 206 patients admitted to Siriraj Hospital or another hospital for supratentorial intracerebral haemorrhage or infarction.


RESULTS
The Siriraj stroke score was developed and calculated as (2.5 x level of consciousness) + (2 x vomiting) + (2 x headache) + (0.1 x diastolic blood pressure) - (3 x atheroma markers) - 12. A score above 1 indicates supratentorial intracerebral haemorrhage, while a score below -1 indicates infarction. The score between 1 and -1 represents an equivocal result needing a computerised brain scan or probability curve to verify the diagnosis. In the validation study of the Siriraj stroke score the diagnostic sensitivities of the score for cerebral haemorrhage and cerebral infarction were 89.3% and 93.2% respectively, with an overall predictive accuracy of 90.3%.


CONCLUSIONS
The Siriraj stroke score is widely accepted and applied in hospitals throughout Thailand as a simple and reliable bedside method for diagnosing acute stroke.
Poungvarin
N
N
Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Viriyavejakul
A
A
Komontri
C
C
D000208:Acute Disease; D001161:Arteriosclerosis / Q000175:diagnosis; D001794:Blood Pressure / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000175:diagnosis*; D002544:Cerebral Infarction / Q000175:diagnosis*; D002561:Cerebrovascular Disorders / Q000175:diagnosis*; D003243:Consciousness / Q000502:physiology; D003937:Diagnosis, Differential; D016002:Discriminant Analysis; D005260:Female; D006261:Headache / Q000175:diagnosis; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D015203:Reproducibility of Results; D014839:Vomiting / Q000175:diagnosis