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Brain Hemorrhages
CHINESE ROOTS
GLOBAL IMPACT
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a r t i c l e i n f o a b s t r a c t
Article history: Introduction: Rapid diagnosis is crucial for stroke patients since it is an emergency that may result in
Received 14 June 2022 morbidity and mortality. The gold standard, which is a CT scan of the brain is not always feasible, hence,
Received in revised form 17 July 2022 Siriraj and Bahrudin Score, as well as Gajah Mada Algorithm are likely to be alternatives.
Accepted 21 July 2022
Objectives: This study aims to determine the specificity and sensitivity of the Siriraj and Bahrudin Score
Available online xxxx
as well as Gajah Mada Algorithm.
Method: A cross-sectional study was undertaken at five network hospitals of the Medical Faculty
Keywords:
University in Muhammadiyah Malang. It involves a sample of 304 medical records used to determine
Bahrudin Score
CT Scan
the sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve with output area
Gajah Mada Algorithm under the curve (AUC).
Siriraj Score Result: The result showed that the sensitivity and specificity of Bahrudin and Siriraj Acore, as well as
Stroke Gajah Mada Algorithm for determining infarct stroke was 91.3% vs 89.7% vs 61.2% and 67.7% vs 69.4%
vs 77.4%, respectively. For determining hemorrhagic stroke the values were 67.7% vs 69.4% vs 77.4%
and 91.3% vs 89.7% vs 61.2%, respectively. Furthermore, the area under the curve of Bahrudin and
Siriraj Scores was better than Gajah Mada Algorithm.
Conclusion: In conclusion, Bahrudin and Siriraj Scores have good accuracy, sensitivity, and specificity in
diagnosing stroke than Gajah Mada Algorithm.
Ó 2022 International Hemorrhagic Stroke Association. Publishing services by Elsevier B.V. on behalf of
KeAi Communications Co. Ltd. This is an open access article under the CC BY license (http://creativecom-
mons.org/licenses/by/4.0/).
Introduction and 2019, the absolute number of incidents and prevalent strokes
increased by 70 % (67.0–73.0) and 85 % (83.0–88.0), respectively.
World Health Organization (WHO) defined stroke as rapidly Mortality and DALYs due to stroke also increased by 43 % (31.0–
developing clinical symptoms of focal or global disturbance of 55.0) and 32 % (22.0–42.0), respectively.3.
the cerebral function, lasting more than 24 h or resulting in death, The leading cause of death in Indonesia is stroke, accounting for
with no apparent cause other than vascular origin.1 The American 328.5 thousand, which is 21.2 % of all mortality in 2012. The coun-
Heart Association/American Stroke Association revised its official try has the highest rate of stroke deaths in Asia as of 2010, with a
definition in 2013 to include silent hemorrhages and infarctions 193.3/100,000 person-years age-sex standardized mortality rate.
in the cerebral, spinal, and retinal areas.1–2 According to the Indonesian Basich Health Research, the preva-
The global burden of disease study reported 12.2 and 101 mil- lence of stroke is 12.1 per million, with North Sulawesi Province
lion incidents and prevalent stroke cases, respectively. It also having the highest rate (17.9 %), followed by Yogyakarta (16.9 %).
reported 143 million disability-adjusted life-years (DALYs) attribu- Furthermore, the risk of stroke increases with age, peaking at 75
table to stroke, and 6.55 million fatalities in 2019. This disease or older, and is equally common in both men and women. It is
remained the world’s second-leading cause of death, accounting more common among men across the world, while women are
for 11.6 %, and the third-leading cause of death and disability com- more severely affected.4–5.
bined, accounting for 5.7 % of total DALYs in 2019. Between 1990 According to several standards, computed tomography remains
the best first-line modality in patients with acute strokes. Although
⇑ Corresponding author.
it is an excellent imaging tool without contrast enhancement for
distinguishing between acute ischemic and hemorrhagic strokes,
E-mail address: neurobahrudin@gmail.com (M. Bahrudin).
https://doi.org/10.1016/j.hest.2022.07.003
2589-238X/Ó 2022 International Hemorrhagic Stroke Association. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd.
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Please cite this article as: M. Bahrudin, P. Yudha Pratama Putra and D. Amalia Eka Putri, Comparison of accuracy, sensitivity and specifity of Bahrudin score
vs Siriraj score vs Gajah Mada algorithm in diagnosing type of stroke, Brain Hemorrhages, https://doi.org/10.1016/j.hest.2022.07.003
M. Bahrudin, P. Yudha Pratama Putra and D. Amalia Eka Putri Brain Hemorrhages xxx (xxxx) xxx
low and middle-income countries (LMICs) still need a CT scanner. Variable Clinical Feature Score
They are expensive and out of reach for the majority of people, Consciousness (based on Glasgow Coma 15 or no alteration 0 2.5
specifically in low-income nations where insurance is unavailable.7 Scale)
Several hospitals in Indonesia have this modality, necessitating the 9–14 1 2.5
need for an early diagnostic tool to distinguish between hemor- 3–8 2 2.5
Vomiting No 02
rhage and ischemic stroke. Yes 12
The Siriraj, Allen, Bahrudin, Guy’s Hospital Stroke Score, and Gajah Headache (within 2 h) No 02
Mada Algorithm are some of the most often utilized scoring systems Yes 12
in Indonesia. Even though the results differ from CT scans, these Diastolic Blood pressure (mmHg) 0.1
Atheroma markers None 03
grading methods have been tested for accuracy.7–11 This study aims
One or more 13
to evaluate the sensitivity, specificity, and accuracy of the Siriraj Constant 12
Score system, Bahrudin Score, and Gajah Mada Algorithm in diagnos-
ing the type of stroke with CT scans. The system’s accuracy is
designed for daily use in the early management of stroke patients, Table 2
particularly in hospitals without neuroimaging modalities. The calculation of Bahrudin score.
system is a reliable substitute for a CT scan when it is unavailable Based on gender, this study report of 58.06 % male is consistent
(Fig. 2). The AUC value of Bahrudin’s and Siriraj’s scores are identi- with the result of Mita et al, which showed that male suffers more
cal at 79.5 %, which can be rounded up to 80 %, with 95 % CI for from strokes than female (66.3 %).16 Aging and population growth
Bahrudin’s diagnostic value ranging from 72.2 % to 86.8 % and Siri- have increased the absolute number of strokes, particularly among
raj’s score ranging from 72.3 % to 86.7 %. These results indicate the the oldest, which is predicted to rise significantly in the future
diagnostic value of Bahrudin and Siriraj Scores is potent. Further- years. Furthermore, more stroke survivors were reported due to
more, Gajah Mada Algorithm has an AUC value of 69.3, which improved treatment, increasing recurrent occurrences. To address
can be rounded up to 70 %, with a 95 % CI range of 62.2 % to this epidemiological threat, immediate action is required.17
76.4 % for Gajah Mada Algorithm’s diagnostic value. This result According to this study, the incidence of stroke increases after
indicates that the algorithm has a moderate diagnostic value. the age of 40 years (95.2 %).
This present study found hypertension among patients with
infarct and hemorrhagic stroke, which is its most common risk fac-
Discussion tor. The causes of stroke and its hemodynamic implications are
diverse, making blood pressure control in patients difficult, hence,
This is the first cross-sectional study in Indonesia that examines accurate diagnosis and specific therapy description targets are
the sensitivity, specificity, and accuracy of Bahrudin, Siriraj, and required.18–19.
Gajah Mada Algorithms in diagnosing stroke. The three diagnostic In recent studies, the loss of consciousness was found more in
tools were compared in this study due to their widespread use in hemorrhagic stroke than infarction. However, they can cause alter-
Indonesia. The result showed that the incidence of infarct stroke ation, cerebral infarction, and hemorrhage covering large sections
was greater than hemorrhagic. Furthermore, infarction is ten times of both hemispheres, or confined regions. The bilateral mesial
more common than hemorrhagic stroke in Western nations, mak- regions, paramedian diencephalon, and upper brainstem also cause
ing their statistical validation difficult.15. consciousness issues.20 Headache and vomiting were also found
3
M. Bahrudin, P. Yudha Pratama Putra and D. Amalia Eka Putri Brain Hemorrhages xxx (xxxx) xxx
Table 3
Demographic characteristic patients.
Gender
Male 138 (57,02%) 36 (58,06%) 174 (57,24%) 0.997
Female 104 (42,98%) 26 (41,94%) 130 (42,76%)
Total 242 (100%) 62 (100%) 304 (100%)
Headache symptoms
Headache 61 (25,21%) 43 (69,35%) 104 (34,21%) 0.000
Without headache 181 (74,79%) 19 (30,65%) 200 (65,79%)
Total 242 (100%) 62 (100%) 304 (100%)
Symptoms of Vomiting
Vomit 19 (7,85%) 40 (64,52%) 59 (19,41%) 0.000
Without Vomit 223 (92,15%) 22 (35,48%) 245 (80,59%)
Total 242 (100%) 62 (100%) 304 (100%)
Blood pressure
normal 92 (38,02%) 9 (14,52%) 101 (33,22%) 0.000
Hypertension 150 (61,98%) 53 (85,48%) 203 (66,78%)
Total 242 (100%) 62 (100%) 304 (100%)
Conclusion
Algorithm. Furthermore, Bahrudin Score has the highest accuracy 8. Rusdi Lamsudin R. Gadjah Mada stroke algorithm - Development and validity for
distinguishing intracerebral hemorrhagic stroke with acute ischemic stroke or
when compared to other two modalities.
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https://jurnal.ugm.ac.id/bik/article/view/4328*/Retrieved.
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study to distinguish supratentorial intracerebral haemorrhage from infarction.
BMJ (Clinical Res ed.). 1991;302:1565–1567. https://doi.org/10.1136/
Ethics approval for this study was granted by the Medical Fac- bmj.302.6792.1565.
ulty University of Muhammadiyah Malang Ethics Research Com- 10. Kabir R, Pramanik MAH, Haque SE, Tabassum M, Sultana F. Superiority of Siriraj
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China ed. 1994;54:407–411. PMID: 7850682.
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JTO.0b013e3181ec173d.
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The authors declare that they have no known competing finan- southeast Nigeria. Internat J Gen Med. 2015;8:349–353. https://doi.org/
cial interests or personal relationships that could have appeared 10.2147/IJGM.S87293.
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