Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 19984

AbstractMaterial and MethodsResultsDiscussionConclusionReferences
Readers' Comments (0) Article in PDF Audio Visual Citation Manager Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : June | Volume : 6 | Issue : 5 | Page : 851 - 854

Comparison of the Siriraj stroke Score and the Guy’s Hospital Score in South India

Pavan Manibettu Raghuram, Mallanagouda Shivanagouda Biradar, Jayakumar Jeganathan

1. Assistant Professor in Medicine Department, Kasturba Medical college-Mangalore (Manipal University), India. 2. Professor in Medicine Department, Sri BM Patil Medical college, Bijapur, India. 3. Associate professor in Medicine Department, Kasturba medical college-Mangalore (Manipal University), India.

Correspondence Address :
Dr. Jayakumar Jeganathan
A-13 RNE Flats, Light House Hill Road, Mangalore,
India -575003.
Phone: 9343351015
E-mail: Jayakumarpsj2@yahoo.co.in

Abstract

Background: CT scan is an important tool in stroke management. Due to its poor availability, we need to look for a simple but reliable scoring system to differentiate the ischaemic from the haemorrhagic strokes in our country.

Aim: To compare the effectiveness of the Siriraj stroke score and the Guy’s hospital score for differentiating the ischaemic from the haemorrhagic strokes.

Settings and Design: This study was conducted in a tertiary care centre in south India. This was a cross-sectional study.

Methods and Material: The Siriraj stroke score and Guy’s hospital score were applied to 100 stroke patients and their results were compared with the CT scan results.

Statistics: The sensitivity, specificity and the positive and the negative predictive values for both the scores were calculated separately. The Mc Nemar test was then used to compare both the scores.

Results: The Siriraj stroke score had a sensitivity and a specificity of 87.93% and 77.27% for ischaemic strokes and for the haemorrhagic strokes, they were 77.27% and 87.93%. The Guy’s hospital score had a sensitivity and a specificity of 94.54% and 80% for ischaemic strokes and for the haemorrhagic strokes, they were 80% and 94.54%. The Mc Nemar test which was used to compare both the scores gave a value of X2=0.25 (p=0.61).This showed that there was no significant difference between the two scores in differentiating the ischaemic from the haemorrhagic strokes.

Conclusion: There were no significant differences between the two scores when it came to differentiating the type of stroke. However, both the scores lacked the accuracy which was required for them to be applied and for guiding the physicians in stroke management.

How to cite this article :

Pavan Manibettu Raghuram, Mallanagouda Shivanagouda Biradar, Jayakumar Jeganathan. COMPARISON OF THE SIRIRAJ STROKE SCORE AND THE GUY’S HOSPITAL SCORE IN SOUTH INDIA. Journal of Clinical and Diagnostic Research [serial online] 2012 June [cited: 2019 Sep 18 ]; 6:851-854. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=June&volume=6&issue=5&page=851-854&id=2227

Introduction
Distinguishing intra-cerebral haemorrhage from infarction on the basis of the clinical features alone is not reliable (1). It is important to make this distinction since the management of these two disorders is entirely different. CT scan is considered as the ideal investigative tool for stroke patients, to make the distinction between an infarct and a haemorrhage (2). But in developing countries like India, due to issues like cost and availability, its use has not been possible universally. Clinical scores for this purpose, like the Siriraj stroke score (SSS), was developed in Thailand (3). The Guy’s hospital score (GHS) was another score that was developed in 1984 (4). When these scores were applied on stroke patients in various populations, the results of these studies were found to vary from place to place. In a study which was done in western India, these two scores were not found to be accurate enough to differentiate the ischaemic from the haemorrhagic strokes (5). Whereas a study which was done by Ozeren et al., on Turkish patients reached a conclusion that these two scores could be used as screening tools in the epidemiological studies on strokes (6). One of the reasons for the inconsistent results may be that these scores were developed initially on one group of patients in one location. Hence, there is a need to validate these scores on various populations to check their reliability and usefulness in the management of stroke cases in that population. As these scores had not been studied in the population of southern India, we planned this study. We planned to compare these two different scores in differentiating the ischaemic from the haemorrhagic strokes.

Aim
To compare the effectiveness of the Siriraj stroke score and the Guy’s hospital score in differentiating the ischaemic from the haemorrhagic strokes.

Objectives
To find the sensitivity, specificity and the positive and the negative predictive values of these two scoring systems in stroke patients.

Material and Methods

100 consecutive patients who presented with acute neurological deficit and who fulfilled the inclusion and exclusion criteria were included in the study after obtaining an informed consent from them. Approval for the study was also obtained from the institutional ethics committee.

Inclusion criteria
1. Diagnosed cases of stroke who fulfilled the WHO criteria (7).

Exclusion criteria
1. Patients who presented after 24 hours of the onset of neurological events.
2. Patients with subarachnoid haemorrhage.
3. Neurological deficit with an associated space occupying lesion in the brain and a head injury.
4. Infratentorial strokes.

All the patients underwent detailed medical and neurological examinations at admission and at the end of 24 hours. All the subjects underwent evaluation to check the status of haemoglobin, fasting and post prandial sugars, serum creatinine, routine urine, lipid profile, ECG and X-ray of the chest. All the patients were subjected to CT scan of the brain immediately. It was repeated again after 48 hours if it was deemed necessary for the diagnosis of an infarction or a haemorrhage. The Siriraj stroke score was calculated immediately after the admission of the patients, as per the original method by Poungvarin et al., (3). The interpretation of the score was done as: scores which were > 1- intracerebral haemorrhage, those which were < - 1- infarction, and those which were between – 1 to + 1- equivocal. The Guy’s hospital score was calculated 24 hours after the onset of the symptoms, according to the method which was described by Allen (4). The scores which were < +4 were taken as infarction, those which were > +24 were taken as haemorrhage and those which were between + 4 to + 24 were taken as equivocal.

Statistics
Both the scores were compared with the CT scan report. The sensitivity, specificity, positive and negative predictive values were calculated for both the Siriraj stroke score and Guy’s score separately. Mc Nemar test was then applied to compare both the scores.

Results

Of the total 100 patients, 50 were males and 50 were females. Of the 100 stroke patients, 71 patients had infarcts and the remaining 29 had haemorrhages. The mean age of our stroke patients was 61.01±14.1 years. The youngest was 19 years old and the oldest was 95 years old. The mean age of the male patients was 61.04±12.32 years. The mean age of the female patients was 60.98±15.82 years. The mean age of the patients who presented with haemorrhages was 65.13±9.78 years. The mean age of the patients who presented with infarctions was 59.32±15.27 years.

Risk factors: As shown in (Table/Fig 1), hypertension was the most common risk factor, which was seen in 37 patients. This was followed by smoking, which was seen in 26 patients. Diabetes mellitus was seen in 18 patients, alcohol consumption was seen in 13 patients, a history of a previous transient ischaemic attack was seen in 11 patients and cardiovascular disease was seen in five patients.

The Siriraj stroke score:In the infarction group, the maximum number of patients had a score which was in the range of (–4 to – 3.1) and in the haemorrhage group, the scores were in the range of (4.1 to 5). In the infarction group, the maximum score was -7 and in the hemorrhage group, the maximum score was + 9. This score gave unequivocal results in 80 cases and equivocal results in 20 cases. Thus, it had an applicability rate of 80%. It wrongly diagnosed 5 cases of haemorrhage as infarction and 7 cases of haemorrhage as infarction, as has been shown in (Table/Fig 2). The sensitivity of the Siriraj score for detecting infarction was 87.93%, its specificity was 77.27%, its positive predictive value was 91.07% and its negative predictive value was 70.83%. Similarly, the sensitivity of the Siriraj score for detecting haemorrhage was 77.27%, its specificity was 87.93%, its positive predictive value was 70.83% and its negative predictive value was 91.07%. The Guy’s hospital score: In the infarction group, the maximum number of patients had a score which was in the range of (-1.0 to 3.9) and in the haemorrhage group, the score was in the range of (24.1 to 29). It gave equivocal results in 25 patients. The maximum score for the infarction group was – 22.4 and for the haemorrhage group, it was + 48.0. The Guy’s hospital score showed definite results in 75 cases and equivocal results in 25 cases. Thus, it had an applicability rate of 75%. It wrongly diagnosed 4 cases of haemorrhagic stroke as infarction and 3 cases of infarction as haemorrhage, as has been shown in (Table/Fig 3). The sensitivity of the Guy’s hospital score for detecting infarction was 94.54%, its specificity was 80%, its positive predictive value was 92.85%, and its negative predictive value was 84.21%. Similarly, the sensitivity of this score for detecting haemorrhage was 80%, its specificity was 94.54%, its positive predictive value was 84.21% and its negative predictive value was 92.85%.

Comparison of both the scores: As shown in (Table/Fig 4), both the scores diagnosed 45 cases as infarction. The identification of haemorrhage by both the scores was possible in 15 cases. The cases with equivocal scores were excluded and only the cases in the unequivocal range were considered and the Mc Nemar test was then applied. We got c2= 0.25 and p=0.61. This shows that there was no significant difference between the Siriraj stroke score and the Guy’s hospital score in differentiating between infarction and haemorrhage.

Discussion

Among the 100 cases, ischaemic strokes were more common as compared to the haemorrhagic strokes. The mean age of the patients who presented with stroke in our study was 61 years. Similar observations were noted by Whadhwani et al in a study which was done in Indore in India (8). The Siriraj stroke score in our study had an applicability rate of 80%. The Guy’s hospital score had an applicability rate of 75%. Kochar et al., in their study in western India, had found an applicability rate of 66.25% for the Siriraj stroke score and of 61.25% for the Guy’s hospital score (9). Hypertension was the most common risk factor which was found in our study. Strong et al estimated that hypertension was the most common risk factor for stroke, which was present in 54% of the cases in their study (10). As has been shown in the (Table/Fig 5), 853 the sensitivity and the positive predictive value of the Siriraj stroke score for haemorrhagic stroke in our study closely matched with that which was found in the study which was done by Kochar et al (9). Whereas the specificity was more closer to that which was found in the study which was done in Malaysia by Kan et al., (11). Zenebe G et al in their study in Ethiopia found that sensitivity of the Siriraj stroke score was very low (12). The sensitivity of the Guy’s hospital score for detecting haemorrhagic stroke in our study was close to that which was found by Sandercock et al., (13). The specificity and the positive predictive values were similar to that which were found by Kochar et al., (9). Though the specificity and positive predictive value of the Guy’s hospital score was very high in the study by Huang JA et al., the sensitivity was found to be very poor (14). As can be seen in [Table/Fig-6], the results of the Siriraj stroke score for ischaemic stroke in our study closely resembled those which were found in the study which was done by Kochar et al., (9). The sensitivity of the Guy’s hospital score for ischaemic stroke in our study was close to that which was found by Kochar et al., (9). Whereas the specificity and the positive predictive values were similar to those which were found in the study which was done by Sandercock et al., in the United Kingdom (13). Hawkins GC et al.,concluded that both the sensitivity and specificity was low for the Guy’s hospital score in ischaemic stroke (15). The Mc Nemar test was used to compare the results of the Siriraj stroke score and the Guy’s hospital score. There was no significant difference between the Siriraj stroke score results and the Guy’s hospital score results in our study. This finding was consistent with the results of a study which was done by Celani et al, who also did not find a significant difference between the two scores. In that study, they finally concluded that where CT was not immediately available and when the clinician wished to start antithrombotic treatment, the Siriraj score (and possibly the Allen score) could be useful in identifying the patients who were at a low risk of intracerebral haemorrhage (16).

Conclusion

1. We did not find any significant difference between the Siriraj stroke score and the Guy’s hospital score in their ability to distinguish the ischaemic from the haemorrhagic strokes.
2. The specificity of both these scores was not good enough when it was compared to that of the CT scan.

Limitations
As our study was done only on the admitted patients in a tertiary referral hospital, these results may not necessarily be applicable to the stroke patients in primary care centres.

References

1.
Bamford J. The clinical examination in the diagnosis and the sub-classification of stroke. Lancet 1992;339:400-02.
2.
Ambrose J. Computerized transverse axial tomography. Part 2. Clinical application. Br J Radiol 1973;46:1023-47.
3.
Poungvarin N, Viriyavejakul A, Komontri C. A Siriraj-stroke and validation study which was done to distinguish supratentorial intracerebral haemorrhage from infarction. BMJ 1991;302:1565-67.
4.
Allen C. Clinical diagnosis of the acute stroke syndrome. QJM 1983;52:515-23.
5.
Soman A, Joshi SR, Tarvade S, Jayaram S. The Greek stroke score, the Siriraj score, and the Allen score in the clinical diagnosis of intra-cerebral haemorrhage and infarction. A validation and comparison study. Indian J Med Sci 2004;58:417-22.
6.
Ozeren A, Bicakci S, Burgut R, Sarica Y, Bozdemir H. Accuracy of the bedside diagnosis versus the Allen and the Siriraj stroke scores in Turkish patients. Eur J Neurol 2006;13:611-15.
7.
Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strass T. Cerebrovascular disease in the community. Results of a WHO collaborative study. Bull World Health Organ 1980;58:113-30.
8.
Whadhwani J, Hussain R, Raman PG. Nature of the lesions in cerebrovascular stroke patients: correlation between the clinical stroke score and computed tomography scan of the brain. J Assoc Physicians India 2002;50:771-81.
9.
Kochar DK, Joshi A, Agarwal N, Aseri S, Sharma BV, Agarwal TD. The poor diagnostic accuracy and the applicability of the Siriraj stroke score and the Allen score and their combination in differentiating acute haemorrhagic and thrombotic stroke. J Assoc Physicians India 2000;48:584-88.
10.
Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol 2007;6:182-87.
11.
Kan CH, Lee SK, Low CS, Velusamy SS, Cheong I. A validation study of the Siriraj stroke score. Int J Clin Pract 2000;54:645-46.
12.
Zenebe G, Asmera J, Alemayehu M. How accurate is the Siriraj stroke score among Ethiopians? A brief communication. Ehiop Med J 2005;43:35-38.
13.
Sandercock PA, Allen CM, Corston RM, Harrison MJ, Warlow CP. Making the clinical diagnosis of intracranial haemorrhage by using the Guy’s hospital score. BMJ (Clin Res Ed) 1985;291:1675-77.
14.
Huang JA, Wang PY, Chang MC, Chia LG, Yang DY, Wu TC. The Allen score in the clinical diagnosis of intracranial haemorrhage. Zhonghua Yi Xue Za Zhi (Taipei) 1994;54:407-11.
15.
Hawkins GC, Bonita R, Broad JB, Anderson NE. Inadequacy of the clinical scoring systems in differentiating the stroke subtypes in population-based studies. Stroke 1995;26:1338-42.
16.
Celani MG, Righetti E, Migliacci R, Zampolini M, Antoniutti L, Grandi FC, et al. The comparability and the validity of two clinical scores in the early differential diagnosis of acute stroke. BMJ 1994;308:1674-76.

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com