Siriraj Stroke Score Research Articles

Clinical diagnosis of stroke patients using SIRIRAJ stroke score and Computed Tomography

Background & Objectives: Stroke is a significant cause of disability and death globally, with ischemic and hemorrhagic types. Rapid diagnosis is critical, particularly in resource-limited settings where access to neuroimaging is restricted. Thus, this study aimed to diagnose stroke patients usingthe Siriraj Stroke Score (SSS) and computed tomography at Janaki Medical College TeachingHospital.Materials and Methods: A total of 97 stroke patients presented within 72 hours of onset atJanaki Medical College Teaching Hospital, Nepal, were included in this study. Patients wereclinically assessed using the SSS and subsequently underwent CT brain scanning to confirm thestroke subtype. The SSS was calculated based on consciousness level, headache, vomiting,atheroma markers, and diastolic blood pressure. The results from SSS were compared with the CTscan findings to determine the clinical diagnosis.Results: The study found that 56.7% of the patients had hemorrhagic strokes, with intraparenchymal hematoma being the most common subtype. The SSS showed a strong correlation with CT scan results, particularly for hemorrhagic strokes, where most patients with a score above 1 were accurately diagnosed.Conclusion: The Siriraj Stroke Score is a valuable tool for initial stroke assessment, especially insettings where advanced neuroimaging is not immediately available. The study supports usingSSS in early stroke management, which could improve patient outcomes in resource-limited environments.

Perbedaan Siriraj Stroke Score (3S) & Dave and Djoenadi Stroke Score System (3S2D) Terhadap Durasi Penentuan Diagnosa Keperawatan Pasien Stroke di IGD

Stroke patient service in the emergency room provided by nurses and must do it quickly, effectively, and efficiently, this can be achieved with the right assessment instrument. Knowing the difference in the assessment of Siriraj Stroke Score (3S) and Dave and Djoenaidi Stroke Score System (3S2D) on the duration of determining the nursing diagnosis of stroke patients in the emergency room. Quantitative research with one group post test only design, and sampling using purposive sampling of 30 respondents. The statistical test uses the Paired Sample T-test test. The results of the Paired Sample T-test test showed that the average difference in the duration of determining nursing diagnoses in 3S and 3S2D assessment was 7.6 minutes. The lowest difference is 7.1 minutes, and the highest difference is 8.1 minutes. It is known that the t value is 29.135> t table 2.045 and Sig. value of 0.000 <0.05. The use of the 3S assessment method is more compatible to be used during emergencies because the assessment method is simple and fast, while the 3S2D assessment is quite time consuming so that this assessment will be easier if it is carried out by 2 nurses

Siriraj Stroke Score Validity in Distinguishing Ischemic from Haemorrhagic Stroke among Patients with Stroke at Saint Francis Hospital in Kampala, Uganda

Siriraj Stroke Score Validity in Distinguishing Ischemic from Haemorrhagic Stroke among Patients with Stroke at Saint Francis Hospital in Kampala, Uganda

The Effectiveness of the Siriraj Stroke Score (SSS) and National Institute of Health Stroke Scale (NIHSS) Assessment Methods in Determining the Actual Nursing Diagnosis of Stroke Patients in the Emergency Room

Background: stroke is a disease of the brain in the form of focal nerve function disorders caused by disruption of blood circulation to the brain and causing symptoms in the form of neurological deficits. As the number of stroke patients increases, the assessment needs to focus on neurology and is an emergency.Purpose: analyzing the effectiveness of the assessment method NSSS and NIHSS in determining the number of diagnoses actual nursing and the speed of time to determine the diagnosis of stroke patients in the Emergency Room.Methods: this study used a pre-experimental approach. Theerty sample were used from a new patient with a medical diagnosis of stroke, while the sampling technique in this study was accidental sampling. Data collection on each sample was directly carried out using two assessment methods. The SSS assessment consists of 5 components and the NIHSS 11 components. Data analysis used sperm correlation and correlation coefficient interpretation test.Results: the results of the sperm correlation test in the SSS and NIHSS methods both show p=0.000. The level of closeness were analyzed using the correlation coefficientthere is a very strong relationship is NIHSS to the length of the duration of determination (r = 0.858).Conclusion: the SSS and NIHSS assessment methods are effective in establishing the diagnosisactual nursingin stroke patients in the Emergency Department, however, in terms of duration of assessment and determination of the number of diagnoses, SSS is more effective, while from the duration of determining nursing diagnoses, NIHSS is more effective.

The Validity of Clinical Scoring in the Diagnosis of Stroke Subtype: Validation Study.

BackgroundThe gold standard for distinguishing stroke subtype is non-contrast CT. However, it’s still prohibitively expensive and out of reach for the majority of recourse-constrained settings. Clinically, not all patients will have a definite diagnosis of hemorrhagic/ischemic stroke. To overcome these challenges and improve clinical bedside diagnosis, clinical stroke scores for stroke subtypes have been developed and recommended to be used in the absence of appropriate imaging modality.MethodsWe conducted a prospective cross-sectional study among stroke patients to compare the accuracy of level of clinical stroke score methods in differentiating stroke type with CT. it was conducted on 140 people at MTU teaching hospital in Bench-Sheko Zone, South-west Ethiopia. Data were collected using check list. Analysis of the data was done using SPSS version 24.ResultsOur result revealed an incidence of hemorrhagic stroke were 50%, ischemic stroke were 48.6% by CT evaluation. Specificity, sensitivity, positive predictive value, negative predictive value and the overall accuracy of Siriraj stroke score for differentiation of hemorrhage from ischemic stroke were 68.6%, 83.9%, 74.6%, 79.5%, and 82% respectively, the Guys score were 89.7%, 47.8%, 73.3%, 74.5% and 74.5% respectively and while the Bensson score were 88.6%, 35.3%, 75%, 58.5%, and 62.3% respectively.ConclusionWe conclude that Siriraj stroke score showed good sensitivity and fair overall accuracy for hemorrhagic stroke even if it had poor specificity.

Reliability of Siriraj stroke score to distinguish between hemorrhagic and ischemic stroke

ObjectiveThe aim of study was to establish a quick way to differentiate between hemorrhagic and ischemic stroke by using siriraj stroke score and find its specificity and sensitivity by comparing it with CT scan findings. Study designCross-sectional study. Place and duration of studyDepartment of Neurology Pakistan Institute of Medical Sciences Islamabad from Jan 2021 to June 2021. MethodologyTotal 110 patients of acute stroke were included. Any patient of > 20 years old, non-traumatic, focal neurological deficit < 14 days with no obvious reason other than vascular were included. Siriraj stroke score was calculated its findings were compared with a CT scan findings. Data was analyzed by SPSS ver.23.0. ResultsThe mean age of patients was 66.10 ± 14.58 years. There were 54 (49.10 %) males and 56 (50.90 %) females. Hypertension was the most common disease found in 79 (71.8 %). The sensitivity, specificity, PPV and NPV of Siriraj stroke score was 83.87 %, 66.6 %, 74.2 % and 71.42 % respectively for hemorrhagic stroke and 93.4 %, 80.95 %, 93.4 % and 37.03 % respectively for non-hemorrhagic stroke. ConclusionIt is an easy, cost effective and bed side scoring system which can accurately identify the stroke type without any other radiological investigation. It can be employed in areas where CT scan facility is not available and treatment can be started early which will definitely lower mortality and morbidity of stroke patients.

Comparison of Siriraj Stroke Score with Computed Tomography to Differentiate Acute Embolic and Hemorrhagic Stroke in a Tertiary Care-Teaching Center

Comparison of Siriraj Stroke Score with Computed Tomography to Differentiate Acute Embolic and Hemorrhagic Stroke in a Tertiary Care-Teaching Center

Superiority of Siriraj Stroke Score Over Guy’s Hospital Score in Diagnosing Acute Hemorrhagic Stroke at Bedside

Background: The clinical diagnosis of stroke in a patient admitted in the intensive care unit (ICU) is undeniably challenging. Several point-based risk scores have been developed to predict clinical outcomes after ischemic stroke. Objective: To assess the Siriraj stroke score and Guy’s Hospital stroke score in the clinical diagnosis of acute stroke. Materials and Methods: All patients were subjected to Computed tomography (CT) scan head within 72 hours of admission. The sensitivity, specificity, positive predictive value was calculated for both the scores. Comparability between the scores and CT scan head finding was determined with the help of Kappa statistic program. Results: Sensitivity of Guy’s Hospital stroke score for ischemic stroke is 100%, specificity is 96.4%, accuracy 97.1%, positive predictive value of 87.5% and negative predictive value 100%. The sensitivity of Guy’s Hospital stroke score for hemorrhage stroke is 96.4%, specificity is 100%, accuracy 97.1%, positive predictive value of 100% and negative predictive value 87.5% Conclusion: Siriraj stroke score as a simple method of screening patients for intracerebral hemorrhage, as it is easier to use at bedside and has a greater accuracy in diagnosing hemorrhage than Guy’s Hospital score. KYAMC Journal. 2021;12(3): 142-146

Siriraj Score as a Tool for Clinical Diagnosis of Stroke

Background: Siriraj stroke score is a diagnostic tool to differentiated ischemic from haemorrhagic shock. This study was carried out to access SSS accuracy as compared to CT scan. Methods: This study was carried out in the Department of Medicine and Neurology of Mayo Hospital, Lahore. Thirty two patients were included in the study who had stroke SSS was applied as well as CT scan was done. Out of them 6% were misdiagnosed. Overall predictive accuracy was 87.5%. Conclusion: Siriraj stroke score is not 100% accurate. CT scan should be advised before starting definitive stroke therapy.

UJI VALIDITAS SIRIRAJ STROKE SCORE, ALGORITMA STROKE GADJAH MADA, SKOR STROKE NUARTHA TERHADAP COMPUTERIZED TOMOGRAPHY SCAN KEPALA DALAM MENENTUKAN JENIS STROKE PADA FASE AKUT

Stroke is a syndrome that is characterized by sudden functional focal and global brain disorder that develops very quickly lasting more than 24 hours (unless there is surgical intervention or bringing death) caused by vascular disorder in the brain (Gofir, 2009). Stroke is the number one cause of serious disability settled worldwide. Stroke is also a leading cause of death worldwide. This research had 87 sample, consisting of 50 men and 37 women. The study was done using patient suspect stroke that enter the emergency room. The analysis result was nuartha’s stroke score has the highest sensitivity and specificity compared to Siriraj Stroke Score and Gadjah Mada Stroke Score. The sensitivity of the Nuartha Stroke Score in diagnosing non hemorrhagic stroke was 94,87 and with a specificity of 94.12%. Whereas for diagnosing hemorrhagic stroke, nuartha stroke score has a sensitivity of 94,12% and specificity of 94.87%. With an accuracy of 94.64%&#x0D;

“Validity of Siriraj Stroke Score in Differentiating Acute Ischemic and Hemorrhagic Stroke”

“Validity of Siriraj Stroke Score in Differentiating Acute Ischemic and Hemorrhagic Stroke”

English

INTRODUCTION: Computed tomography (CT) scan is an accurate, safe, non-invasive procedure routinely used as an investigative tool for stroke to distinguish between infarction and haemorrhage. Computed tomography scanning of brain is expensive in both the initial investment and maintenance. In developing countries like India, cost and availability constraints prohibit its widespread use especially in rural areas. Clinical stroke scores were developed to overcome these limitations. Differential diagnosis between infarction and haemorrhage can be made on clinical grounds with aid of Siriraj Scoring System. CT scan is not readily available in semi-urban and rural areas and the scoring systems will then come into play in differentiating the stroke subtype. This study is being done to determine the sensitivity, specificity of Siriraj score AIMS AND OBJECTIVES 1. To differentiate between cerebral infarct and intra cerebral hemorrhage on the basis of Siriraj Stroke Score. 2. To find out the sensitivity, specificity and overall accuracy of the scoring system by comparing it with the CT scan findings. MATERIALS & METHOD: Cross-sectional study was conducted among patient from general medicine ward of Govt. Rajaji hospital Madurai during the period of March 2016 to august 2016. Study included 60 cases of stroke. Subjects believed to fulfill all eligibility criteria, and none of the exclusion criteria were included in the study. METHODOLOGY: On admission detailed history and thorough clinical examination including neurological assessment will be carried out. Patients will be assumed to be fully conscious if they had a score of >13 on the Glasgow Coma Scale (GCS), drowsy if they had a GCS score of 8–13 and unconscious if they scored <7. Siriraj Stroke Score will be calculated and compared with the CT findings done on admission. A radiologist from the hospital, blind to the clinical features, will classify the CT brain scans as either infarction or haemorrhage. Siriraj Stroke Score (SSS) will be calculated using the formula = (2.5×level of consciousness) + (2×vomiting) + (2×headache) + (0.1×diastolic blood pressure) - (3×atheroma markers) -12. RESULT: Our study included 60 patients. The mean age of the patients was 60.2 years. 65 % were males and 35% were females.75 % patient had infarction in the CT scan. 25% patients had haemorrhage on CT scan.51.66% were predicted on siriraj score to have ischemic stroke out of 45 infarction cases. 30% were predicted to have haemorrhagic stroke on siriraj score. 18.3% were inconclusive. In this study, Siriraj score showed positive predictive value of 80.64% for ischemic stroke and negative predictive value of 78.57% for hemorrhagic stroke and the P value is 0.015 (significant). CONCLUSION: Based on clinical variables such as level of consciousness, blood pressure, atheroma markers and the presence of headache and vomiting, Siriraj Stroke Score, a clinical scoring can be used for the bedside diagnosis of the nature of the lesion in stroke patients where CT scan is not available immediately.

Assessment of homocysteine, Vitamin B12, and Zinc levels among patients with acute ischemic stroke in Northwestern Nigeria

Background: Stroke has been a global burden, with increasing morbidity and mortality. Several risk factors have been identified, which are the target of preventive strategies, they include hyperhomocysteinemia, hypovitaminosis B12, and low zinc levels. There is paucity of data on the biochemical risk factors in our environment which necessitated this study. Objective: To evaluate the serum levels of homocysteine, vitamin B12, and zinc in patients with acute ischemic stroke in Zaria. Patients and Methods: This is a case-control study conducted over 13 months in ABUTH Zaria. One hundred patients with clinical diagnosis of ischemic stroke diagnosed, confirmed by brain CT-scan and Siriraj stroke score of less than -1, and equal number of apparently healthy age, and sex-matched were recruited. Their fasting serum homocysteine and vitamin B12 were measured using enzyme-linked immunosorbent assay, while zinc was measured using direct colorimetric method. Stroke severity was determined using National Institute of Health Stroke Score (NIHSS), patients with NIHSS score of 1–4, 5–15, and 16–42 were classified as mild, moderate, and severe stroke respectively. Results: Mean serum homocysteine for patients was significantly higher than that of controls (P < 0.05) and mean serum zinc and vitamin B12significantly lower compared to that of controls (P < 0.05). There was no association between hyperhomocysteinemia, low vitaminB12, and low zinc concentrations with the severity of stroke using NHISS Score. Conclusion: Elevated serum homocysteine, low vitamin B12, and zinc were found to be significant risk factors associated with ischemic stroke.

Use of a Diagnostic Score to Prioritize Computed Tomographic (CT) Imaging for Patients Suspected of Ischemic Stroke Who May Benefit from Thrombolytic Therapy.

BackgroundA shortage of computed tomographic (CT) machines in low and middle income countries often results in delayed CT imaging for patients suspected of a stroke. Yet, time constraint is one of the most important aspects for patients with an ischemic stroke to benefit from thrombolytic therapy. We set out to assess whether application of the Siriraj Stroke Score is able to assist physicians in prioritizing patients with a high probability of having an ischemic stroke for urgent CT imaging.MethodsFrom the Malaysian National Neurology Registry, we selected patients aged 18 years and over with clinical features suggesting of a stroke, who arrived in the hospital 4.5 hours or less from ictus. The prioritization of receiving CT imaging was left to the discretion of the treating physician. We applied the Siriraj Stroke Score to all patients, refitted the score and defined a cut-off value to best distinguish an ischemic stroke from a hemorrhagic stroke.ResultsOf the 2176 patients included, 73% had an ischemic stroke. Only 33% of the ischemic stroke patients had CT imaging within 4.5 hours. The median door-to-scan time for these patients was 4 hours (IQR: 1;16). With the recalibrated score, it would have been possible to prioritize 95% (95% CI: 94%–96%) of patients with an ischemic stroke for urgent CT imaging.ConclusionsIn settings where CT imaging capacity is limited, we propose the use of the Siriraj Stroke Score to prioritize patients with a probable ischemic stroke for urgent CT imaging.

Validation of Siriraj Stroke Score in southeast Nigeria.

The aim of the study is to validate the use of Siriraj Stroke Score (SSS) in the diagnosis of acute hemorrhagic and acute ischemic stroke in southeast Nigeria. This was a prospective study on validity of SSS in the diagnosis of stroke types in southeast Nigeria. Subjects diagnosed with stroke for whom brain computerized tomography (CT) scan was performed on admission were recruited during the study period. SSS was calculated for each subject, and the SSS diagnosis was compared with brain CT scan-based diagnosis. A total of 2,307 patients were admitted in the hospital medical wards during the study period, of whom 360 (15.6%) were stroke patients and of these, 113 (31.4%) adult subjects met the inclusion criteria. The mean age of the subjects was 66.5±2.6 years. The mean interval between ictus and presentation was 2.5±0.4 days. Ischemic stroke was confirmed by CT in 74 subjects; however, SSS predicted 60 (81.1%) of these subjects correctly (P<0.05). Hemorrhagic stroke was confirmed by CT in 39 subjects, and SSS predicted 36 (92.3%) of them correctly (P<0.05). In acute ischemic stroke, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SSS were 92%, 94%, 97%, 86%, and 93%, respectively, while in patients with hemorrhagic stroke, the corresponding percentages were 94%, 92%, 86%, 97%, and 93%, respectively. SSS is not reliable enough to clinically differentiate stroke types in southeast Nigeria to warrant interventions like thrombolysis in acute ischemic stroke.

Comparison of Siriraj Stroke Score with Computerized Tomography in Establishing the Type of the Stroke among Pakistani Population

Computed Tomography (CT) Scan is an accurate and a routinely done imaging technique to diagnose and differentiate haemorrhagic and ischaemic stroke. Siriraj Stroke Score (SSS) is weighted clinical score and European recognized for clinical and bedside differentiation between ischemic and haemorrhagic stroke. This study aimed to establish the accuracy of SSS in the bedside diagnosis of cerebral haemorrhage in comparison with CT scan to avoid delay in treatment. Total 152 patients were included in the study. Out of which 39.5% were male. Overall, mean age was 59.28±11.91, 56.32 ±12.69 in haemorrhagic group and 62.32±10.28 in non-haemorrhagic group. Sensitivity, specificity, PPV, and NPV of SSS for haemorrhagic stroke was 71.4%, 81.3%, 79.7% and 73.5% respectively. Overall accuracy for haemorrhagic stroke was found to be 76.3%. SSS had higher sensitivity for haemorrhagic stroke and is more sensitive in Asian population, but still not accurate enough to replace CT scan as investigation of choice but can plays a role to avoid delay in the management where CT scan is delayed or not available.

Comparison of Siriraj Stroke Score With Computerized Tomography in Establishing the Type of the Stroke Among Pakistani Population (P1.078)

Comparison of Siriraj Stroke Score With Computerized Tomography in Establishing the Type of the Stroke Among Pakistani Population (P1.078)

Accuracy of clinical stroke scores for distinguishing stroke subtypes in resource poor settings: A systematic review of diagnostic test accuracy.

Background:Stroke is the second leading cause of death globally. Computerized tomography is used to distinguish between ischemic and hemorrhagic subtypes, but it is expensive and unavailable in low and middle income countries. Clinical stroke scores are proposed to differentiate between stroke subtypes but their reliability is unknown.Materials and Methods:We searched online databases for studies written in English and identified articles using predefined criteria. We considered studies in which the Siriraj, Guy's Hospital, Besson and Greek stroke scores were compared to computerized tomography as the reference standard. We calculated the pooled sensitivity and specificity of the clinical stroke scores using a bivariate mixed effects binomial regression model.Results:In meta-analysis, sensitivity and specificity for the Siriraj stroke score, were 0.69 (95% CI 0.62-0.75) and 0.83 (95% CI 0.75-0.88) for ischemic stroke and 0.65 (95% CI 0.56-0.73) and 0.88 (95% CI 0.83-0.91) for hemorrhagic stroke. For the Guy's hospital stroke score overall sensitivity and specificity were 0.70 (95% CI 0.53-0.83) and 0.79 (95% CI 0.68-0.87) for ischemic stroke and 0.54 (95% CI 0.42-0.66) and 0.89 (95% CI 0.83-0.94) for hemorrhagic stroke.Conclusions:Clinical stroke scores are not accurate enough for use in clinical or epidemiological settings. Computerized tomography is recommended for differentiating stroke subtypes. Larger studies using different patient populations are required for validation of clinical stroke scores.

Clinical stroke scores for distinguishing stroke subtypes: a systematic review of diagnostic test accuracy

Background Stroke is a major cause of morbidity and mortality especially in low and middle income countries. Computerized tomography is used to distinguish between ischemic and hemorrhagic subtypes, but it is expensive and unavailable in some low and middle income countries. Clinical stroke scores are proposed to differentiate between ischemic and hemorrhagic stroke but their reliability is unknown. Objective To synthesize the best available research evidence on the accuracy of clinical scores in distinguishing ischemic and hemorrhagic stroke in patients with acute stroke. Inclusion Criteria Participants Patients admitted to hospital with acute stroke according to the World Health Organization criteria, regardless of age, sex or ethnicity. Intervention This review considered studies that evaluated the Siriraj, Guy’s Hospital, Besson and Greek stroke scores compared to computerized tomography as the reference standard. Outcomes The sensitivity and specificity of the clinical stroke scores compared to computerized tomography results in distinguishing between stroke subtypes. Types of Studies This review considered studies of diagnostic test accuracy in which the index test(s) and reference standard were interpreted independently of one another on the same group of participants. Search Strategy We searched online databases for published and unpublished studies written in English and identified articles using predefined criteria. Methodological Quality Papers selected for retrieval were assessed by four independent reviewers for methodological validity prior to inclusion in the review using the QU ality A ssessment of D iagnostic A ccuracy S tudies tool. Data Extraction A modified Joanna Briggs Institute data extraction form was used to collect details from included studies. Data Synthesis A bivariate mixed effects binomial regression model was used to statistically pool data in meta-analysis. A narrative synthesis was undertaken where statistical pooling was not feasible. Results For studies from low and middle income countries, overall sensitivity and specificity for the Siriraj stroke score were 0.69 (95% CI 0.62-0.75) and 0.83 (95% CI 0.75-0.88) for ischemic stroke and 0.65 (95% CI 0.56-0.73) and 0.88 (95% CI 0.83-0.91) for hemorrhagic stroke. For the Guy’s hospital stroke score, overall sensitivity and specificity were 0.70 (95% CI 0.53-0.83) and 0.79 (95% CI 0.68-0.87) for ischemic stroke and 0.54 (95% CI 0.42-0.66) and 0.89 (95% CI 0.83-0.94) for hemorrhagic stroke. For the Greek stroke score, sensitivity and specificity ranged from 0.39 to 0.64 and 0.63 to 0.88 for ischemic stroke and 0.11 to 0.44 and 0.63 to 0.96 for hemorrhagic stroke. Discussion Clinical stroke scores were developed for use in settings where computerized tomography scan is unavailable to differentiate between stroke subtypes but they minimally alter the post-test probability of disease and thus are not sufficiently accurate to replace neuro-imaging in differentiating stroke subtypes. Conclusions Clinical stroke scores are not accurate enough for use in clinical or epidemiological settings. Use of computerized tomography is recommended for differentiating stroke subtypes.

A comparison of clinical diagnosis with Computed Tomography findings in stroke patients

Objective: To compare clinical diagnosis with computed tomography findings in identifying the types of stroke. Materials and Methods: The study was carried out after obtaining approval from the Institutional Ethical Committee, in the Department of Medicine, RIMS, Imphal, Manipur, from October 2010 to September 2012. The study sample consisted of 150 patients presenting with first-ever acute stroke who were clinically evaluated. An interviewer-structured questionnaire was administered and Siriraj stroke score computed. Clinical diagnosis of stroke-type (hemorrhagic or ischemic) was made based on Siriraj stroke score. The stroke-type was classified and compared with CT scan diagnosis. Data were analyzed using SPSS 16 software. Results: There were 150 patients in the study sample, out of them, 71 were hemorrhagic stroke patients and remaining 79 were ischemic stroke patients diagnosed by CT scan. The correlation between stroke-type, headache, level of consciousness at presentation, vomiting, and diastolic blood pressure achieved statistical significance. Sensitivity, specificity, positive predictive value, and negative predictive values of Siriraj stroke score for cerebral hemorrhage were 78.87%, 91.13%, 88.88%, and 82.75%, respectively. Conclusion: Hemorrhagic and ischemic stroke cannot be distinguished clinically with a simple clinical evaluation, and it is virtually impossible for all stroke patients to have a computed tomography scan immediately after admission, especially in rural area. When computed tomography is not immediately available and the clinician wishes to start anti-thrombotic treatment, the clinical diagnosis based on the Siriraj stroke score can be useful to identify patients at low risk of intracerebral hemorrhage.