Hawkins G C, Bonita R, Broad J B, Anderson N E
Department of Community Health, University of Auckland, New Zealand.
Stroke. 1995 Aug;26(8):1338-42. doi: 10.1161/01.str.26.8.1338.
We undertook to examine the usefulness for epidemiological studies of two well-known validated clinical scoring methods, the Guys' Hospital Stroke score and the Siriraj Hospital Stroke score, to classify strokes into the two main types, hemorrhagic and ischemic, in epidemiological studies.
Patients from a population-based stroke register who received either a CT scan or an autopsy were retrospectively scored using the two clinical scoring methods. The scores were then compared with the CT scan and autopsy results to determine the sensitivity, specificity, and positive predictive value for intracranial hemorrhage (primary intracerebral and subarachnoid hemorrhage) and ischemic stroke.
Over a 12-month period, 554 patients from a population-based study underwent CT scanning. Films or autopsy reports were available for 521 patients, and of these, sufficient clinical information to calculate the Guys' Hospital Stroke score and the Siriraj Hospital Stroke score was available for 464 and 475 patients, respectively. For the Guys' Hospital Stroke score, the sensitivity and specificity for intracranial hemorrhage were 31% and 95%, respectively; the positive predictive value was 73%. The sensitivity and specificity for ischemic stroke were 78% and 70%, respectively, and the positive predictive value was 86%. For the Siriraj Hospital Stroke score, the sensitivity and the specificity for intracranial hemorrhage were 48% and 85%, respectively; the positive predictive value was 59%. The sensitivity and specificity for ischemic stroke were 61% and 74%, respectively, and the positive predictive value was 84%.
This validation study suggests that both clinical scores lack sufficient validity to be used in epidemiological studies for classification of stroke types and should probably not be used in the randomization of patients into treatment trials using thrombolytic or antithrombotic drugs in the absence of diagnostic information based on neuroimaging techniques.
我们试图检验两种著名的经过验证的临床评分方法，即盖伊医院卒中评分和诗里拉吉医院卒中评分，在流行病学研究中对卒中进行两种主要类型（出血性和缺血性）分类的实用性。
对来自基于人群的卒中登记处且接受了CT扫描或尸检的患者，采用这两种临床评分方法进行回顾性评分。然后将评分与CT扫描及尸检结果进行比较，以确定对颅内出血（原发性脑内出血和蛛网膜下腔出血）和缺血性卒中的敏感性、特异性及阳性预测值。
在为期12个月的时间里，来自一项基于人群研究的554例患者接受了CT扫描。521例患者有影像学胶片或尸检报告，其中分别有464例和475例患者具备足够的临床信息来计算盖伊医院卒中评分和诗里拉吉医院卒中评分。对于盖伊医院卒中评分，颅内出血的敏感性和特异性分别为31%和95%；阳性预测值为73%。缺血性卒中的敏感性和特异性分别为78%和70%，阳性预测值为86%。对于诗里拉吉医院卒中评分，颅内出血的敏感性和特异性分别为48%和85%；阳性预测值为59%。缺血性卒中的敏感性和特异性分别为61%和74%，阳性预测值为84%。
这项验证研究表明，这两种临床评分均缺乏足够的有效性，无法用于卒中类型分类的流行病学研究，并且在缺乏基于神经影像学技术的诊断信息时，可能不应将其用于将患者随机分组至使用溶栓或抗血栓药物的治疗试验中。
