Validation study of the Siriraj stroke score in North-east Nigeria

The management and prognosis of stroke depends on the correct assessment of its pathological sub-type. It is therefore pertinent to have a simple and quick means of evaluating patients with stroke. The Siriraj stroke score (SSS) was developed in Thailand based on clinical parameters and have a good predictive value. This study aims at validating the Siriraj stroke score, as the predictive value of any diagnostic score depends on the prevalence of the disease in the community.

Patients who had stroke less than fourteen days before admission were enrolled into the study. Clinical variables for calculating the Siriraj stroke score were documented all patients subsequently had computerized tomography scan performed. A total of fifty patients were studied from University of Maiduguri Teaching Hospital and the State Specialist Hospital Maiduguri.

Twenty-seven patients had infarction while twenty-three patients had hemorrhagic strokes respectively, based on the CT scan findings. The Siriraj stroke score correctly diagnosed fourteen as infarction and twenty as having hemorrhagic strokes, sixteen subjects were unclassified. The SSS correctly diagnosed thirteen cases as infarctive and seventeen as hemorrhagic strokes as confirmed by CT scan. The sensitivity and the predictive value of the SSS were 76.2% and 93% for infarction and 94.4% and 85% for hemorrhagic stroke respectively with overall accuracy of 84.6%. The clinical variables such as headache, vomiting and atheroma markers did not show discriminant value independently in differentiating CI and CH. However, level of Consciousness (coma) and diastolic blood pressure of greater than 110 mmHg are discriminant variables in differentiating CI and CH.

Siriraj stroke score is recommended to be used in this community especially where CT scan is not available or affordable and the physician wishes to start thrombolytic or/and anticoagulation therapy.