Materials and Methods
Results
Materials and Methods
This prospective cross-sectional study was conducted at Mizan-Tepi University Teaching and Referral Hospital , Mizan-Aman town , on a total of 140 patients with an acute stroke ( 109 males , and 31 females ). Data were collected from both young and aged subjects using the checklist which was adapted from the World Health Organization ( WHO ) manual [ 1 ]. CT images were also sequentially sampled for further interpretations . Data analysis was done using SPSS , version 24 to determine the sensitivity , specificity , positive and negative predictive value , and overall accuracy compared with CT scan results of patients . The target population was composed of all acute stroke patients who live in Bench-Maji , Keffa , and Sheka Zones and surrounding areas of Gambella , Oromia and Southern nations , and nationalities . We sampled individuals who were admitted to the emergency outpatient department of the referral hospital for the diagnosis of stroke subtypes .
All acute stroke patients whose CT scan results showed infarction or haemorrhagic stroke and other patients with any neurological deficit lasting for more than 24 hours were included in this study . Patients with secondary complications as a result of other etiologies like tuberculosis , tumours , trauma , or patients with subarachnoid haemorrhage , and patients whose neurologic deficits were resolved within 24 hours were excluded from this study .
The study tools were designed based on the WHO manual which included two variables , the first containing information about the socio-demographic profile , and the second containing clinical variables . To ensure the validity of the study tools , intensive training was provided to all data collectors and supervisors . The neuroradiologist was blinded to the clinical feature and the clinical score interpretation and was requested to report only the scan images as having cerebral haemorrhage or infarction . In the assessment of disease progression bias , 15 days were considered an appropriate period between onset of stroke and administration of reference standards . This period helps to avoid interpreting resolving haemorrhages as infarcts and accommodates the lack of sensitivity of CT scans in early ischemic stroke . The equivocal results of each clinical score finding and those who showed normal diagnosis from CT scan were excluded from the final cross-tabulation analysis .
Socio-demographic characteristics ( age , sex , level of education residency , etc .) clinical variable ( level of consciousness , headache within 2 hours , diastolic blood pressure , atheroma markers , apoplectic response , plantar response , history of hypertension , history of heart disease , transient ischemic attack , white blood cell count of greater than12000 , neurological deterioration within 3 hours , history of alcohol intake , history of hyperlipidaemia , diabetes mellitus , atrial fibrillation at admission , angina , intermittent claudication ) were documented at first arrival , after 3 hours and after 24 hours at the bedside and the CT scan was done in all the patients . The scores were calculated from the above variables for each patient independently by using each stroke score calculation and the definition and guidelines were followed as per the original scores [ 29 ].
Results
In our analysis , out of 140 patients who participated in this study , 109 ( 77.9 %) were males and 31 ( 22.1 %) were females . The participants ’ age ranged from 18 to 100 , with a mean of 54.66 (± 16.86 ) years . Our findings showed that 70 ( 50 %) were haemorrhagic and 68 ( 48.6 %) ischemic stroke patients , while 2 ( 1.4 %) were normal ( Figure 1 ).
Among the 140 acute stroke patients , Siriraj stroke score values 64 ( 45.7 %) were haemorrhagic , 45 ( 42.1 %) ischemic , and 31 ( 22.1 %) equivocal ; by Guys stroke score values 15 ( 10.7 %) haemorrhagic , 49 ( 35 %) ischemic and 78 ( 54.3 %) equivocal ; by Greek stroke score value 24 ( 17.1 %) haemorrhagic , 38 ( 27 %) ischemic and 78 ( 55.7 %) patients equivocal ; and by Besson stroke score value 108 ( 77.1 %) haemorrhagic and 32 ( 22.9 %) ischemic stroke type ( Figure 2 ).