Validation of Siriraj Stroke Score in southeast Nigeria

Abstract

Innocent Ijezie Chukwuonye,1 Kenneth Arinze Ohagwu,2 Enoch Ogbonnaya Uche,3,4 Abali Chuku,5 Rowland Ihezuo Nwanke,2 Christopher Chukwuemeka Ohagwu,6 Ignatius U Ezeani,7 Collins Ogbonna Nwabuko,8 Martin Anazodo Nnoli,9 Efosa Oviasu,4,10 Okechukwu Samuel Ogah4,11 1Division of Nephrology, 2Division of Neurology, Department of Internal Medicine, Federal Medical Centre, Umuahia, Nigeria; 3Division of Neurosurgery, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria; 4Federal Medical Centre, Umuahia, Nigeria; 5Department of Ophthalmology, Federal Medical Centre, Umuahia, Nigeria; 6Department of Radiography, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria; 7Division of Endocrinology, Department of Internal Medicine, Federal Medical Centre, Umuahia, Nigeria; 8Department of Hematology, Federal Medical Centre, Umuahia, Nigeria; 9Department of Anatomical Pathology, University of Calabar, Calabar, Nigeria; 10Division of Nephrology, Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Nigeria; 11Division of Cardiology, University College Hospital Ibadan, Ibadan, Nigeria Abstract: The aim of the study is to validate the use of Siriraj Stroke Score (SSS) in the diagnosis of acute hemorrhagic and acute ischemic stroke in southeast Nigeria. This was a prospective study on validity of SSS in the diagnosis of stroke types in southeast Nigeria. Subjects diagnosed with stroke for whom brain computerized tomography (CT) scan was performed on admission were recruited during the study period. SSS was calculated for each subject, and the SSS diagnosis was compared with brain CT scan-based diagnosis. A total of 2,307 patients were admitted in the hospital medical wards during the study period, of whom 360 (15.6%) were stroke patients and of these, 113 (31.4%) adult subjects met the inclusion criteria. The mean age of the subjects was 66.5±2.6 years. The mean interval between ictus and presentation was 2.5±0.4 days. Ischemic stroke was confirmed by CT in 74 subjects; however, SSS predicted 60 (81.1%) of these subjects correctly (P<0.05). Hemorrhagic stroke was confirmed by CT in 39 subjects, and SSS predicted 36 (92.3%) of them correctly (P<0.05). In acute ischemic stroke, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SSS were 92%, 94%, 97%, 86%, and 93%, respectively, while in patients with hemorrhagic stroke, the corresponding percentages were 94%, 92%, 86%, 97%, and 93%, respectively. SSS is not reliable enough to clinically differentiate stroke types in southeast Nigeria to warrant interventions like thrombolysis in acute ischemic stroke. Keywords: stroke, Siriraj Stroke Score (SSS), hemorrhagic stroke, acute ischemic stroke, CT scan