Comparison of Two Hospital Stroke Scores with Computerized Tomography in Ascertaining Stroke Type Among Nigerians

Abstract

Background: Stroke, a major cause of morbidity and mortality is on the increase in Nigeria, routine Computerized Tomography (CT) for all Nigerians with stroke is not available to most doctors, and this poses management problems. We compared two available clinical scores with brain CT for the differential diagnosis of cerebral ischemia and hemorrhage among adult Nigerians with first-ever acute stroke. Methods: The study was conducted at the State Specialist Hospital Maiduguri. Ninety-five adult Nigerians presenting with first-ever acute stroke onset within 48 hours were evaluated with the Siriraj Hospital Stroke (SHS) score on presentation and the Guy's Hospital Stroke (GHS) score 24 hours after admission. CT brain scan was considered as gold standard. These two stroke scores were compared with the results of CT brain and sensitivity, specificity; positive predictive and negative values were calculated. Results: Applying the recommended optimum cut-off points for the 2 scores, diagnoses were classified by the Guy's Hospital Stroke and Siriraj Hospital Stroke score as probable hemorrhagic strokes (49% and 25% respectively) and probable ischemic (40% and 65% respectively). The remainder were classified as "uncertain." The prevalence of hemorrhage diagnosed by gold standard (CT) was 29.5% while the prevalence of ischemic stroke diagnosed by CT was 54.7%. The CT brain was normal in 15.8%. Sensitivity, specificity, positive predictive value and negative predictive value for cerebral hemorrhage was 0.64, 0.48, 0.4 and 0.71 for Guy's Hospital Stroke score and 0.35, 0.73, 0.4 and 0.68 for Siriraj Hospital Stroke score. Conclusion: It is evident from the study that these clinical scoring systems alone are not sufficient and one has to employ the use of computerized tomography scan in establishing stroke type in Nigerians with stroke.Fond: La course, une cause importante de la morbidit\ue9 et la mortalit\ue9 est en augmentation du Nig\ue9ria, la tomographie automatis\ue9e par routine (CT) pour tous les nig\ue9riens avec la course n'est pas \ue0 la disposition de la plupart des m\ue9decins, et ceci pose des probl\ue8mes de gestion. Nous avons compar\ue9 deux points cliniques disponibles au cerveau CT pour le diagnostic diff\ue9rentiel de l'isch\ue9mie et de l'h\ue9morragie c\ue9r\ue9brales parmi des nig\ue9riens d'adulte avec la premi\ue8re course aigu\ueb. M\ue9thodes: L'\ue9tude a \ue9t\ue9 entreprise \ue0 l'h\uf4pital Maiduguri de sp\ue9cialiste en \ue9tat. Quatre-vingt-quinze nig\ue9riens d'adulte se pr\ue9sentant avec le premier d\ue9but aigu de course dans un d\ue9lai de 48 heures ont \ue9t\ue9 \ue9valu\ue9s avec les points de la course d'h\uf4pital de Siriraj (SHS) sur la pr\ue9sentation et les points de la course de l'h\uf4pital du type (GHS) 24 heures apr\ue8s admission. Le balayage de cerveau de CT a \ue9t\ue9 consid\ue9r\ue9 comme \ue9talon or or. Ces points de deux courses ont \ue9t\ue9 compar\ue9s aux r\ue9sultats du cerveau de CT et de la sensibilit\ue9, sp\ue9cificit\ue9 ; des valeurs pr\ue9dictives et n\ue9gatives positives ont \ue9t\ue9 calcul\ue9es. R\ue9sultats: Appliquant les points optima recommand\ue9s de coupure pour les 2 points, des diagnostics ont \ue9t\ue9 classifi\ue9s par les points de course de l'h\uf4pital du type et de course d'h\uf4pital de Siriraj en tant que les courses h\ue9morragiques probables (49% et 25% respectivement) et isch\ue9mique probable (40% et 65% respectivement). Le reste ont \ue9t\ue9 classifi\ue9s comme \uab incertain. \ubb La pr\ue9dominance de l'h\ue9morragie diagnostiqu\ue9e par l'\ue9talon or or (CT) \ue9tait 29.5% tandis que la pr\ue9dominance de la course isch\ue9mique diagnostiqu\ue9e par CT \ue9tait 54.7%. Le cerveau de CT \ue9tait normal dans 15.8%. La sensibilit\ue9, la sp\ue9cificit\ue9, la valeur pr\ue9dictive positive et la valeur pr\ue9dictive n\ue9gative pour l'h\ue9morragie c\ue9r\ue9brale \ue9taient 0.64, 0.48, 0.4 et 0.71 pour les points de course de l'h\uf4pital du type et 0.35, 0.73, 0.4 et 0.68 pour des points de course d'h\uf4pital de Siriraj. Conclusion: Il est \ue9vident de l'\ue9tude que ces seuls syst\ue8mes de notation cliniques ne sont pas suffisants et on doit utiliser l'utilisation du balayage automatis\ue9 de tomographie en \ue9tablissant la course saisissent des nig\ue9riens avec la course