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

Recently, a new diagnostic scoring system has been proposed to help differentiate intracranial hemorrhage (ICH) from ischemic infarct. The system, derived using data from hospitalized stroke patients, is based on eight variables readily available to all clinicians. A diagnostic score <1.0 is reportedly 100% predictive of ischemic infarct. The clinical scoring system is asserted to be a useful adjunct in the initial evaluation of patients with acute stroke syndrome. The purpose of this study was to prospectively evaluate this clinical scoring system in our emergency department (ED). Sixty-one ED patients with focal neurologic deficit undergoing cranial computed tomography (CT) scan to rule out ICH were entered in the study. Thirteen [21% (95% CI, 12-34%)] were found to have an ICH. Twenty-two [36% (95% CI, 24-49%)] had a diagnostic score < 1.0. The CT scans on 4 of these 22 patients showed ICH. The positive predictive value for ischemic infarct for these 22 patients using the diagnostic scoring system was 82% (95% CI, 60-95%). Our results suggest that this new clinical scoring system is of no value in helping to differentiate ICH from ischemic stroke in the acute care setting.