Lack of clinical utility of the Siriraj Stroke Score

The ability to distinguish between infarct and haemorrhage is essential to the management of acute cerebrovascular disease. In hospitals where emergency neuroimaging is not available, the use of stroke scores has been proposed to distinguish ischaemic from haemorrhagic stroke.

To determine the accuracy of the Siriraj Stroke Score in distinguishing ischaemic from haemorrhagic stroke in a cohort of Chinese patients.

We prospectively assessed and calculated the Siriraj Stroke Score from 253 patients with acute stroke. The sensitivity, specificity, positive and negative predictive values of this score were determined.

For cerebral haemorrhage, the sensitivity and specificity were both 90% or above, but the positive predictive value was not greater than 70%. For cerebral infarct, the sensitivity and specificity were around 80%, while the positive predictive value exceeded 90%. Analysis by plotting receiver operating characteristic curves failed to find other cut-off points that would improve the performance of the Siriraj Stroke Score.

Considering the inconsistent results from this study and previous studies of the Siriraj Stroke Score, we suggest that scoring systems that only require a small number of variables are unlikely to achieve the level of accuracy needed for clinical decision-making.