Validation of siriraj stroke scoring system in the clinical differentiation of stroke sub-types in a resource-limited setting

Abstract

Background: Stroke remains one of the major non-communicable public health disease conditions with resultant
high morbidity and mortality. Neuroimaging in the form of Computed Tomography (CT) or Magnetic Resonance
Imaging (MRI) is adjudged to be the most reliable and efficient method of accurately diagnosing stroke and ruling
out differentials. However, in view of cost implication and non-availability, a clinical scoring system known as the
Siriraj Stroke Score (SSS) was developed to clinically differentiate stroke types, especially in resource-limited
settings. This study sought to validate and determine the role of Siriraj stroke score in the clinical evaluation of
patients presenting with acute stroke.
Methodology: This is a descriptive prospective study that was conducted over a one-year period. The study
populations were adult patients presenting with acute stroke in a tertiary health facility in North-Western Nigeria.
Clinical details with neuroimaging in the form of a CT scan were obtained. Data obtained was analyzed using Stata
15.
Result: Fifty-four percent (54%) of patients enrolled were males and ischaemic stroke is the commonest stroke
subtype present in 69% of patients studied. Altered levels of consciousness, headache and vomiting are important
discriminatory variables of the scoring system. The sensitivity, specificity, Positive Predictive Value (PPV),
Negative Predictive Value (NPV) and accuracy of Siriraj Stroke Score for haemorrhagic stroke is 92%, 72%, 62%,
95% and 62% respectively.
Conclusion: Siriraj Stroke Score with sensitivity greater than 90% is reliable in differentiating the stroke subtypes; the patients in the ‘grey zone’ will however require neuroimaging.