Poor accuracy of stroke scoring systems for differential clinical diagnosis of intracranial haemorrhage and infarction

Weir, Christopher J.; Murray, Gordon D.; Adams, Fg; Muir, K. W.; Grosset, Donald G.; Lees, KR

doi:10.1016/s0140-6736(94)91648-9

Cited by 110 publications

(68 citation statements)

References 8 publications

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“…These stroke scoring systems, however, are inadequate for accurately differentiating between the two stroke types. 128 Hematomas, even just a few millimeters in diameter, are rapidly and accurately identified on CT scans. Not only does CT scanning demonstrate the size and location of the SICH, but it can also suggest potential causes such as tumor, vascular malformation, or aneurysm.…”

Section: Neurosurg Focus / Volume 15 / October 2003mentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

149

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Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial. To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.

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Section: Neurosurg Focus / Volume 15 / October 2003mentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

149

View full text Add to dashboard Cite

show abstract

“…Ebell (2008) designed a simple scoring system to determine prognosis for people who have had acute stroke. Scoring systems based on discriminant analysis have also been developed such as the Allen score and the Siriraj stroke score (Weir et al, 1994). While these stroke scoring systems have been useful, it is rather different than the purpose of this research which is to reduce stroke risk factors based on known variables.…”

Section: Previous Researches On Stroke Scoring and Risksmentioning

confidence: 99%

Expert-System Based Medical Stroke Prevention

Anindito¹

2013

Journal of Computer Science

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Stroke always comes unexpected and the general public is not usually aware of its symptoms. Individuals who have had their first stroke with permanent damage could become an economic burden to their family and a social burden to the society due to their unproductive nature. Stroke could be prevented and its risk factors have been identified. Through a stroke prevention information system, the user could be made more aware of stroke risks and symptoms. An expert system would be able to direct and motivate users to keep themselves healthy therefore preventing first and recurrent strokes. The expert system is built using an inference engine that provides stroke risk level based on information provided by the user. Information collected are self measured blood pressure, cigarettes consumed, amount of physical activity and body mass index. Users are presented with suggested preventive tasks to reduce their stroke risk.

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“…on the use of anticoagulants). [32][33][34][35] Although patients with PICH may in general have more severe stroke symptoms, PICH can also cause transient symptoms lasting for just a few hours [transient ischaemic attack (TIA)], [36][37][38][39] or very minor stroke. 40 However, it is not known how frequently PICH causes minor stroke or TIA.…”

Section: Is Brain Imaging Really Necessary To Differentiate Ischaemicmentioning

confidence: 99%

“…As it is not possible to distinguish reliably between cerebral infarction and haemorrhage on clinical grounds, 34,35 or to identify those few patients with underlying tumours or infections mimicking a stroke, brain imaging with CT or magnetic resonance (MR) is required. Acute haemorrhage on CT appears hyperdense (or white), whereas acute infarction appears hypodense (or dark) compared with normal brain parenchyma.…”

Section: The Need For Brain Imagingmentioning

confidence: 99%

“…30 However, further testing of these scores showed that they were much less accurate when used in a stroke population other than the one from which they were derived. 34,35 In one study, the sensitivity of the Allen score (using a cut-off of >24 to indicate a high likelihood of haemorrhage) dropped to 31% and the sensitivity of a Siriraj score of >1, to 48%. 35 These scores are cumbersome as well as unreliable.…”

Section: The Clinical Diagnosis Of Stroke Versus Not Stroke and Of Imentioning

confidence: 99%

See 1 more Smart Citation

What is the best imaging strategy for acute stroke?

Wardlaw

Keir

Seymour

et al. 2005

Int J Technol Assess Health Care

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTAWhat is the best imaging strategy for acute stroke? NHS R&D HTA ProgrammeT he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS.Initially, six HTA panels (pharmaceuticals, acute sector, primary and community care, diagnostics and imaging, population screening, methodology) helped to set the research priorities for the HTA Programme. However, during the past few years there have been a number of changes in and around NHS R&D, such as the establishment of the National Institute for Clinical Excellence (NICE) and the creation of three new research programmes: Service Delivery and Organisation (SDO); New and Emerging Applications of Technology (NEAT); and the Methodology Programme.This has meant that the HTA panels can now focus more explicitly on health technologies ('health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care) rather than settings of care. Therefore the panel structure was replaced in 2000 by three new panels: Pharmaceuticals; Therapeutic Procedures (including devices and operations); and Diagnostic Technologies and Screening.The HTA Programme will continue to commission both primary and secondary research. The HTA Commissioning Board, supported by the National Coordinat...

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Poor accuracy of stroke scoring systems for differential clinical diagnosis of intracranial haemorrhage and infarction

Cited by 110 publications

References 8 publications

Spontaneous intracerebral hemorrhage: a review

Spontaneous intracerebral hemorrhage: a review

Expert-System Based Medical Stroke Prevention

What is the best imaging strategy for acute stroke?

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