Bedside utility of clinical scoring systems in classifying stroke

Area of Science:

• Neurology
• Medical Diagnostics
• Stroke Medicine

Background:

• Stroke diagnosis relies on clinical assessment and neuroimaging.
• Several clinical scoring systems exist to aid in stroke diagnosis.
• Validation of these scores in diverse patient populations is crucial.

Purpose of the Study:

• To validate and compare the diagnostic accuracy of four stroke scoring systems: Siriraj, Guy's Hospital, Greek, and Besson scores.
• To determine the most effective score for identifying ischemic stroke and intracranial hemorrhage.

Main Methods:

• A cohort of 200 stroke patients was studied.
• Clinical stroke scores were assessed and compared against computed tomography (CT) scans of the brain.
• Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated for each score.

Main Results:

• The Greek score demonstrated the highest diagnostic accuracy for both ischemic stroke (AUC 0.973) and intracranial hemorrhage.
• For ischemic stroke, the Greek score achieved 73% sensitivity and 98% specificity.
• The Greek score's optimal cut-off (1.5) identified 47% of ischemic stroke patients, suggesting its utility in early management.

Conclusions:

• The Greek score is the most effective among the evaluated scores for diagnosing stroke.
• A new discriminant cut-off value for the Greek score can facilitate earlier initiation of anti-platelet therapy while awaiting CT confirmation.