Identification Of Bedside Clinical Scoring Systems In Classifying Stroke And Its Subsequent Management

Abstract

Background and objectives Stroke is the third leading cause of premature death globally and is associated with up to 5.54 million deaths every year, two thirds of which occur in resource poor countries.2 early identification of ischemic stroke is crucial as it leads to earlier treatment initiation with aspirin. Neuro-Imaging techniques have been valuable to distinguish between these Ischemic and hemorrhagic stroke. Quite unfortunately a large group of the population do not have access to these facilities, and even if accessible most of them find it unaffordable. To overcome these difficulties and to enhance clinical bedside diagnosis, clinical stroke scores have been developed. The most commonly used ones include the Besson score (BS), 13 the Greek stroke score (GSS) 14 and the Siriraj stroke score (SSS).15 The objectives of present study were to identify which of the scores have the best sensitivity and specificity to identify between ischemic and haemorrhagic stroke in our Indian population within our demographic setting. Methods The present 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. Relevant data was collected by a detailed interview with patient or the attender, clinical examination, lab reports and neuro-imaging. 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. These findings were noted on a predesigned and pretested proforma. Statistical test –Mann Whitney-U test and Chi-square tests also may be used for analysis. Results 61 patients (42 patients (68.85%) ischemic stroke and 19 patients (31.15%) hemorrhagic stroke) were included in our study. For hemorrhagic stroke Greek score had the highest specificity (97.62%) while Siriraj score had the highest sensitivity (78.95%). For ischemic stroke Besson score had the highest specificity (94.74%) while Siriraj score had the highest sensitivity (80.95%). The Siriraj scoring system was better tool of scoring in identifying type of stroke in our study with the highest AUC (0.902) on the ROC curve. Conclusion In the present involving 61 patients with Stroke, on comparing different scoring systems (GS, SS & BS), we found SS was a better scoring system for both types of strokes. Although these scoring systems help in differentiating ischemic and hemorrhagic stroke on arrival of patients to the casualty, all have certain limitations. Hence we feel neuroimaging is the still the best in differentiating the type of stroke.