Kochar D K, Joshi A, Agarwal N, Aseri S, Sharma B V, Agarwal T D
Department of Medicine, Neurology Section, SP Medical College, Bikaner-334 003.
J Assoc Physicians India. 2000 Jun;48(6):584-8.
To evaluate the relevance of bed side clinical diagnostic scoring systems--Siriraj stroke score (SSS), Allen score and their combined use for differentiating acute haemorrhagic and thrombotic stroke.
The study was conducted on 240 admitted patients of stroke over a period of two years. SSS was calculated immediately and Allen score, 24 hours after admission. CT scan was done immediately and 48 hours after admission if required. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic gain were calculated for both the scores. Comparability between the scores and CT scan finding was determined with the help of kappa statistic programme. Receiver operating characteristic curves (ROC) were plotted to assess the diagnostic accuracy of both scores over a range of cut-off points.
One hundred and thirty four patients (55.83%) had infarction and 106 patients (44.17%) had haemorrhage. SSS was applicable in 66.25% patients (159 out of 240) while Allen score was applicable in only 61.25% patients (147 our of 240). The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic gain for SSS were 73%, 85%, 85%, 71% and 30% for infarction and 85%, 73%, 71%, 85% and 27% for haemorrhage respectively, whereas the corresponding figures for Allen score were 91%, 60%, 77%, 82% and 18% for infarction and 60%, 91%, 82%, 77% and 41% for haemorrhage respectively. There was overall moderate comparability between SSS and Allen score for diagnosing supratentorial stroke (k = 0.396). The comparability of these scores in terms of certain results was worse (k = 0.143). However when the results that were within the diagnostic range with both the scores were considered, the agreement in diagnosing infarction and haemorrhage was almost perfect (k = 0.874). While considering CT scan finding as gold standard for differentiation of infarction and haemorrhage, the overall accuracy of SSS and Allen score was seventy eight percent.
(a) Applicability of SSS only in 66.25% patients and wrong diagnosis in 22.01% patients does not reflect its usefulness because adequate management of stroke requires a gold standard diagnosis which is only possible by immediate CT scan. (b) Allen score is not useful because it can be assessed only after 24 hours of onset of stroke. This deprives the management to all thrombotic patients in speculated time window of modern management.
评估床旁临床诊断评分系统——诗里拉吉卒中评分（SSS）、艾伦评分及其联合应用在鉴别急性出血性和血栓性卒中方面的相关性。
本研究对240例入院的卒中患者进行了为期两年的观察。入院时立即计算SSS，入院24小时后计算艾伦评分。如有需要，入院时及入院48小时后进行CT扫描。计算两种评分的敏感性、特异性、阳性预测值、阴性预测值和诊断增益。借助kappa统计程序确定评分与CT扫描结果之间的可比性。绘制受试者工作特征曲线（ROC）以评估两种评分在一系列截断点范围内的诊断准确性。
134例患者（55.83%）发生梗死，106例患者（44.17%）发生出血。SSS适用于66.25%的患者（240例中的159例），而艾伦评分仅适用于61.25%的患者（240例中的147例）。SSS对于梗死的敏感性、特异性、阳性预测值、阴性预测值和诊断增益分别为73%、85%、85%、71%和30%，对于出血分别为85%、73%、71%、85%和27%；而艾伦评分对于梗死的相应数字分别为91%、60%、77%、82%和18%，对于出血分别为60%、91%、82%、77%和41%。在诊断幕上卒中方面，SSS和艾伦评分总体具有中等可比性（κ = 0.396）。在某些结果方面，这些评分的可比性较差（κ = 0.143）。然而，当考虑两种评分均在诊断范围内的结果时，在诊断梗死和出血方面的一致性几乎完美（κ = 0.874）。将CT扫描结果作为鉴别梗死和出血的金标准时，SSS和艾伦评分的总体准确率为78%。
（a）SSS仅适用于66.25%的患者，且22.01%的患者诊断错误，这并不能反映其有用性，因为卒中的恰当管理需要金标准诊断，而这只有通过立即进行CT扫描才能实现。（b）艾伦评分无用，因为它只能在卒中发病24小时后进行评估。这使得在现代管理的推测时间窗内无法对所有血栓性患者进行管理。
