Validation study of the Siriraj stroke score in African Nigerians and evaluation of the discriminant values of its parameters: A preliminary prospective CT scan study
Department of Medicine, Ogun State University Teaching Hospital Sagamu, Ogun State, Nigeria; Department of Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; West African Post Graduate Medical College, Yaba, Lagos State, Nigeria; Departme
BACKGROUND AND PURPOSE - CT scanning is important to identify stroke pathology and exclude mimics. Its poor availability in our environment makes the search for simple, reliable clinical-score imperative. This study aims to validate the Siriraj Stroke score (SSS) and determine the discriminant values of its parameters in the black population of African-Nigerians. METHODS - A prospective multicenter study was carried out on patients that presented with stroke and had brain CT scan done within 14 days of onset. An interviewer structured questionnaire was administered and SSS computed. The stroke-type was classified and compared with CT diagnosis. Data were analyzed using Epi-info-2002. RESULTS - 1122 patients presented with clinical features of stroke, of which only 101 (9%) could afford the cost of CT scan. Of these, 90 had CT-scan features consistent with acute stroke, 5 had cortical atrophy and 1 was normal. Thus, 96 patients were analyzed, of which 68 (71%) had cerebral ischemia and 28 (29%) had intracerebral hemorrhage. The 6 patients with no visible infarct on CT were regarded as cerebral infarction. The correlation between SSS, headache, vomiting, loss-of-consciousness and CT diagnosis achieved statistical significance, whereas atheroma markers and diastolic blood pressure did not. The SSS has an overall predictive accuracy of 80%. CONCLUSIONS - This preliminary study has shown that only 9% of our hospital stroke population had benefit of CT scan. The limited number of patients studied and their potential lack of representativeness, represent a funding issue to properly establish the performance of clinical scoring systems and assist in descriptive epidemiology of hospital and community-based stroke studies in resource-poor settings. However, in this study, the SSS diagnosis correlates significantly with CT diagnosis. © 2006 American Heart Association, Inc.
adult; aged; article; atheroma; brain atrophy; brain hemorrhage; brain infarction; brain ischemia; clinical feature; clinical trial; community; comparative study; computer assisted tomography; consciousness level; controlled clinical trial; controlled study; correlation analysis; diagnostic accuracy; diagnostic procedure; diastolic blood pressure; discriminant validity; female; headache; health care cost; hospital; human; interview; major clinical study; male; multicenter study; Negro; prediction; priority journal; prospective study; questionnaire; statistical significance; stroke; validation process; vomiting; brain hemorrhage; brain infarction; cerebrovascular accident; computer assisted tomography; differential diagnosis; discriminant analysis; economics; hospitalization; middle aged; Negro; Nigeria; pathophysiology; radiography; sensitivity and specificity; statistics; validation study; Adult; African Continental Ancestry Group; Aged; Aged, 80 and over; Cerebral Hemorrhage; Cerebral Infarction; Cerebrovascular Accident; Diagnosis, Differential; Discriminant Analysis; Female; Health Care Costs; Humans; Male; Middle Aged; Nigeria; Prospective Studies; Questionnaires; Sensitivity and Specificity; Severity of Illness Index; Tomography, X-Ray Computed