COMPARABILITY AND VALIDITY OF SIRIRAJ STROKE SCORE AND ALLEN STROKE SCORE IN DIFFERENTIATION OF ACUTE ISCHEMIC AND HAEMORRHAGIC STROKE

Abstract

Objective: To compare and validate Allen stroke score (ASS) and Siriraj stroke scores (SSS) indifferentiating acute cerebral hemorrhage (CH) and cerebral infarction (CI).Methodology: This comparative, analytical study was conducted at Khyber Teaching Hospital Peshawar,Pakistan from July 2000 to February 2002. Study included 100 patients of acute ishemic or hemorrhagicstroke confirmed on CT scan brain after clinically evaluation. ASS & SSS were calculated for each patientand compared with the results of CT scan for comparability (Kappa Statistics) and validity by using SPSS10.Results: Out of 100 patients, 69 had CI and 31 had CH. The overall comparability of ASS & SSS was fair(Kappa=0.51). ASS & SSS were uncertain in 27 & 18 cases respectively; with Kappa showing worstcomparability in term of certain results (K= 0.23). In 64 cases with both scores in the diagnostic range,the Kappa showing excellent comparability (K=0.91).The sensitivity, specificity, positive predictive value(PPV) and negative predictive value (NPV) of ASS was 38.70%, 91.30%, 66.67%, 76.82% respectively forCH and 71.1%, 80.64%, 89.09% and 55.56% respectively for CI, with overall predictive accuracy of 61%.The sensitivity, specificity, PPV and NPV of SSS was 67.74%, 94.2%, 84% and 86.67% respectively forCH and 78.26%, 90.32%, 94.73% and 65.11% respectively for CI, with overall predictive accuracy of 75%.Conclusion: Although, SSS being simple with more accuracy is better than ASS, both these scores lacksufficient validity to be used for exclusion of cerebral haemorrhage before offering antithrombotic orthrombolytic therapy.