title: Use of a Diagnostic Score to Prioritize Computed Tomographic (CT) Imaging for Patients Suspected of Ischemic Stroke Who May Benefit from Thrombolytic Therapy.
abstract: BACKGROUND
  A shortage of computed tomographic (CT) machines in low and middle income countries often results in delayed CT imaging for patients suspected of a stroke. Yet, time constraint is one of the most important aspects for patients with an ischemic stroke to benefit from thrombolytic therapy. We set out to assess whether application of the Siriraj Stroke Score is able to assist physicians in prioritizing patients with a high probability of having an ischemic stroke for urgent CT imaging.
  
  
  METHODS
  From the Malaysian National Neurology Registry, we selected patients aged 18 years and over with clinical features suggesting of a stroke, who arrived in the hospital 4.5 hours or less from ictus. The prioritization of receiving CT imaging was left to the discretion of the treating physician. We applied the Siriraj Stroke Score to all patients, refitted the score and defined a cut-off value to best distinguish an ischemic stroke from a hemorrhagic stroke.
  
  
  RESULTS
  Of the 2176 patients included, 73% had an ischemic stroke. Only 33% of the ischemic stroke patients had CT imaging within 4.5 hours. The median door-to-scan time for these patients was 4 hours (IQR: 1;16). With the recalibrated score, it would have been possible to prioritize 95% (95% CI: 94%-96%) of patients with an ischemic stroke for urgent CT imaging.
  
  
  CONCLUSIONS
  In settings where CT imaging capacity is limited, we propose the use of the Siriraj Stroke Score to prioritize patients with a probable ischemic stroke for urgent CT imaging.
authors: National Clinical Research Centre, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Wen Yea
authors: http://orcid.org/0000-0002-6755-920X
authors: WY
authors: Hwong
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Michiel L
authors: ML
authors: Bots
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Sharmini
authors: S
authors: Selvarajah
authors: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: L Jaap
authors: LJ
authors: Kappelle
authors: Department of Neurology, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia.
authors: Zariah
authors: Z
authors: Abdul Aziz
authors: Department of Pharmacy, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia.
authors: Norsima Nazifah
authors: NN
authors: Sidek
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Ilonca
authors: I
authors: Vaartjes
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed