Clinical distinction between acute hemorrhagic and acute ischemic stroke by Siriraj stroke score

The clinical distinction between hemorrhagic and ischemic stroke cannot be achieved by simple clinical evaluation, and it is impossible to submit all stroke patients to computed tomography. A simple, reliable, and safe diagnostic tool for acute stroke syndrome is needed. This study tested the Siriraj stroke score to verify its accuracy for distinguishing among the pathological subtypes of stroke.

This study included the one hundred and seventy-one patients with acute supratentorial stroke syndromes consecutively admitted to the Emergency Room of the Taichung Veterans General Hospital from April 1 to September 30, 1993. The Siriraj stroke score was calculated, then compared with results of computed tomography. The Siriraj stroke score was calculated as (2.5 x level of consciousness) + (2 x vomiting) + (2 x headache) + (0.1 x diastolic blood pressure) - (3 x atheroma markers) - 12. A score above 1 indicates supratentorial intracranial hemorrhage, while a score below -1 indicates infarction. The score between 1 and -1 represents an equivocal result needing further evaluation to verify diagnosis.

The diagnostic sensitivities of the Siriraj stroke score for intracranial hemorrhage and infarction were 85% and 90% respectively, with an overall predictive accuracy of 88.5%. When three cases with subarachnoid hemorrhage whose scores were all above 1 were excluded, the sensitivities for cerebral hemorrhage and infarction were 83.8% and 90% respectively, with an overall predictive accuracy of 88.2%.

The Siriraj stroke score can be used as a reliable bedside method for diagnosing acute stroke and for deciding which patients should have priority for computed tomography, it is also a valuable tool for epidemiology studies of stroke incidence and outcome.