This Article Full Text Full Text (PDF) All Versions of this Article: 38/1/62    most recent 01.STR.0000251853.62387.68v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Connor, M. D. Articles by Warlow, C. P. Search for Related Content PubMed PubMed Citation Articles by Connor, M. D. Articles by Warlow, C. P. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Cerebrovascular disease/stroke CT and MRI Acute Cerebral Hemorrhage Acute Cerebral Infarction Emergency treatment of Stroke Other Stroke Treatment - Medical Epidemiology

(Stroke. 2007;38:62.)
© 2007 American Heart Association, Inc.

Original Contributions

Accuracy of the Siriraj and Guy’s Hospital Stroke Scores in Urban South Africans

From the Division of Neurology, Department of Neurosciences (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Division of Neurology, Department of Neurosciences (G.M.), University of the Witwatersrand, Johannesburg, South Africa; and the Department of Clinical Neurosciences (C.P.W.), Western General Hospital, Edinburgh, United Kingdom.

Correspondence to Dr Myles D. Connor, Division of Neurology, Department of Neurosciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa. E-mail mconnor{at}mighty.co.za; connormd@medicine.wits.ac.za

Background and Purpose— The burden of stroke in sub-Saharan Africa is already high and likely to increase, but few patients with stroke have access to brain imaging. Distinguishing pathologic stroke types is relevant both for clinical management and epidemiologic studies. We assessed the accuracy of two stroke scores in distinguishing stroke types in a population known to have a high prevalence of intracranial hemorrhage but low prevalence of atherosclerosis and compared them with the clinicians’ assessment of stroke type with computed tomography brain scanning as the "gold standard."

Methods— We assessed the stroke scores and the clinicians’ blind assessment of pathologic stroke type in consecutive black patients with stroke included in the Johannesburg Hospital Stroke Register over 23 months. We calculated the accuracy of the scores and clinicians compared with computed tomography brain scan (sensitivity, specificity, positive predictive value, likelihood ratio, statistic).

Results— Two hundred twenty-two patients were scanned and assessed within 15 days. Sixty-two (28%) had cerebral hemorrhage and nine (4%) subarachnoid hemorrhage. Neither the Siriraj (sub-Saharan Africa) nor Guy’s Hospital score was accurate or offered much advantage over clinician assessment (sensitivity 0.60 and 0.34, specificity 0.88 and 0.95 for intracranial hemorrhage in the Siriraj Stroke Score and Guy’s Hospital Stroke Score, respectively; sensitivity 0.70 and 0.71, specificity 0.84 and 0.74, respectively, for ischemic stroke). Although the scores were more accurate when we used new cutoff points, they then failed to diagnose over 80% of stroke types.

Conclusions— The Siriraj Stroke Score and Guy’s Hospital Stroke Score are not sufficiently accurate for use in either epidemiologic studies or to guide clinical management in sub-Saharan Africa at present.

Key Words: Africa south of the Sahara • South Africa • cerebral hemorrhage • cerebral infarction • cerebrovascular accident • diagnosis • subarachnoid hemorrhage

This article has been cited by other articles:

				M. D. Connor, G. Modi, and C. P. Warlow Differences in the Nature of Stroke in a Multiethnic Urban South African Population: The Johannesburg Hospital Stroke Register Stroke, February 1, 2009; 40(2): 355 - 362. [Abstract] [Full Text] [PDF]