A New Clinical Scoring System Fails to Differentiate Hemorrhagic from Ischemic Stroke When Used in the Acute Care Setting

Mader, Timothy J.; Mandel, Adam S.

doi:10.1016/s0736-4679(97)00237-0

Cited by 14 publications

(12 citation statements)

References 9 publications

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“…The most recent score, derived by Besson et al . [9], is rather complex to calculate as it uses eight variables with the respective coefficients and has been shown to be insufficient in providing a threshold to diagnose ICH with a high positive predictive value [18].…”

Section: Discussionmentioning

confidence: 99%

“…The Siriraj score [8] is much easier to determine, and can be used immediately after the stroke; nevertheless, it has failed to achieve high sensitivity and specificity in validation studies outside Thailand [11,12,14,15,17], where the pretest probability of haemorrhage is higher than in Europe. The most recent score, derived by Besson et al [9], is rather complex to calculate as it uses eight variables with the respective coefficients and has been shown to be insufficient in providing a threshold to diagnose ICH with a high positive predictive value [18].…”

Section: Discussionmentioning

confidence: 99%

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A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke

Efstathiou

Tsioulos

Zacharos

et al. 2002

Journal of Internal Medicine

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Purpose. To develop a simple and reliable diagnostic tool for differentiation of cerebral infarction (CIF) from intracerebral haemorrhage (ICH) in order to aid clinicians to decide about starting antiplatelet therapy in settings where rapid access to computed tomography (CT) is lacking. Methods. Thirty variables regarding each patient admitted with acute stroke were recorded and considered in a logistic regression analysis using ICH as end-point (internal study). CT was used as the golden standard. The score derived was validated with data from the next consecutive stroke patients and was compared with the three preexisting scores (external validation study). Results. Amongst 235 patients (119 males, mean age 70.6 ± 11.2 years) of the internal study, 43 (18.3%) had ICH. Four independent correlates of ICH were identified and used for the derivation of the following integer-based scoring system: number of points ¼ 6 * (neurological deterioration within 3 h from admission) + 4 * (vomiting) + 4 * (WBC > 12 000) + 3 * (decreased level of consciousness). In the external study [168 patients, 85 males, mean age 70.2 ± 10.8 years, 31 (18.5%) with ICH], when the cut-offs £3 points for CIF and ‡11 points for ICH were used, sensitivity, specificity, and positive and negative predictive values of the score for detection of stroke type were 97, 99, 97 and 99%, respectively; exceeding noticeably the three previously proposed systems.Conclusions. The proposed model provides an easy to use tool for sufficiently accurate differentiation between haemorrhagic and nonhaemorrhagic stroke on the basis of information available to all physicians early after admission.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke

Efstathiou

Tsioulos

Zacharos

et al. 2002

Journal of Internal Medicine

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“…For example, the Allen score is strongly weighted towards features of severe ICH including a history of loss of consciousness at stroke onset and decreased consciousness or the presence of bilateral extensor plantar responses 24 h post-stroke. When scores have been independently validated, they have often been criticised for being insensitive in detecting ICH,12 34 35 possibly because cases with less debilitating stroke were missed. When the Siriraj score was applied to our cohorts with minor stroke, 29% of cases with ICH were missed in the OXVASC cohort and 87% in the hospital clinic-based cohort.…”

Section: Discussionmentioning

confidence: 99%

The SCAN rule: a clinical rule to reduce CT misdiagnosis of intracerebral haemorrhage in minor stroke

Lovelock

Redgrave

Briley

et al. 2009

Journal of Neurology, Neurosurgery & Psychiatry

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Many patients with minor stroke are referred to outpatient clinics and are not scanned immediately. A clinical rule is needed to identify patients who are likely to have intracerebral haemorrhage (ICH) and require urgent brain imaging and patients who can safely start antiplatelet agents before scanning. Methods Clinical factors associated with ICH were determined in 334 consecutive patients with minor stroke (National Institute of Health Stroke Scale score #3), and a predictive model for ICH that was validated in a cohort of 280 patients presenting to a hospitalestroke clinic was derived. Prognostic value was quantified as the area under the ROC curve (c statistics). Results The proportion of ICH in minor stroke was 5.1% (95% CI 3.2% to 8.0%) in OXVASC, and 5.4% (3.3% to 8.7%) in the clinic cohort. Clinical factors predictive of ICH in OXVASC included blood pressure on initial assessment $180/110 mm Hg (OR 14.5, 95% CI 1.8 to 114, p¼0.001), vomiting (OR 15.7, 95% CI 5.4 to 46, p<0.001), confusion (OR 8.2, 95% CI 2.9 to 23, p<0.001) and anticoagulation use (OR 7.8, 95% CI 2.2 to 28, p¼0.006), and at least one predictive factor was identified in all 17 patients with ICH and in 35% overall (c statistic 0.92, 95% CI 0.88 to 0.97). Therefore, we derived the SCAN rule to identify ICH if $1 of the following were present: (S) severe hypertension, (C) confusion, (A) anticoagulation, (N) nausea and vomiting. In the clinic validation cohort, $1 predictive factor was identified in 14/15 of patients with ICH and in 24% overall (c statistic 0.87, 95% CI 0.79 to 0.95). Conclusion The SCAN rule appears to be specific and sensitive at identifying ICH in an independent cohort of patients with minor stroke, although further independent validations are needed.

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“…12,13 Noncontrast head computed tomography (CT) is the imaging modality most readily available in most stroke centers. CT is sensitive to intracranial hemorrhage and may be rapidly performed as part of the acute stroke evaluation.…”

Section: Neuroimagingmentioning

confidence: 99%

Acute Ischemic Stroke Management: Medical Management

Barrett

Meschia

2010

Semin Neurol

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The initial management of a patient with suspected stroke necessitates a rapid and focused evaluation. Establishing the time of symptom onset, performing a focused neurologic examination, and interpreting ancillary tests facilitates delivery of acute stroke therapies to eligible patients. This review emphasizes the fundamentals of urgent stroke evaluation and evidence-based acute ischemic stroke therapies. Results from randomized clinical trials of intravenous thrombolysis, glucose management, and blood pressure management in acute ischemic stroke patients will be highlighted. External ultrasound as an adjunct to intravenous thrombolysis and treatment of those patients that wake up with stroke symptoms will also be discussed.

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A New Clinical Scoring System Fails to Differentiate Hemorrhagic from Ischemic Stroke When Used in the Acute Care Setting

Cited by 14 publications

References 9 publications

A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke

A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke

The SCAN rule: a clinical rule to reduce CT misdiagnosis of intracerebral haemorrhage in minor stroke

Acute Ischemic Stroke Management: Medical Management

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