The role of the Cincinnati Prehospital Stroke Scale in the emergency department: evidence from a systematic review and meta-analysis

References

• Setacci C, Lanza G, Ricci S, et al.; Stroke Prevention and Educational Awareness Diffusion (SPREAD). SPREAD Italian Guidelines for stroke. Indications for carotid endarterectomy and stenting. J Cardiovasc Surg (Torino). 2009;50(2):171–182.
   PubMed Web of Science ®Google Scholar
• Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics¾2018 update: a report from the American Heart Association. Circulation. 2018. doi:10.1161/CIR.0000000000000558
   Web of Science ®Google Scholar
• GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211–1259.
   PubMed Web of Science ®Google Scholar
• Schmidt M, Jacobsen JB, Johnsen SP, Bøtker HE, Sørensen HT. Eighteen-year trends in stroke mortality and the prognostic influence of comorbidity. Neurology. 2014;82(4):340–350. doi:10.1212/WNL.0000000000000062
   PubMed Web of Science ®Google Scholar
• Koton S, Schneider ALC, Rosamond WD, et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014;312(3):259–268. doi:10.1001/jama.2014.7692
   PubMed Web of Science ®Google Scholar
• US Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310:591–608. doi:10.1001/jama.2013.13805
   PubMed Web of Science ®Google Scholar
• Saver JL. Time is brain–quantified. Stroke. 2006;37(1):263–266. doi:10.1161/01.STR.0000196957.55928.ab
   PubMed Web of Science ®Google Scholar
• Lees KR, Bluhmki E, von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010;375(9727):1695–1703. doi:10.1016/S0140-6736(10)60491-6
   PubMed Web of Science ®Google Scholar
• Pashapour A, Atalu A, Farhoudi M, et al. Early and intermediate prognosis of intravenous thrombolytic therapy in acute ischemic stroke subtypes according to the causative classification of stroke system. Pak J Med Sci. 2013;29(1):181–186. doi:10.12669/pjms.291.2897
   PubMed Web of Science ®Google Scholar
• Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012;379(9834):2364–2372. doi:10.1016/S0140-6736(12)60738-7
   PubMed Web of Science ®Google Scholar
• Kothari RU, Hall K, Brott T, Broderick J. Early stroke recognition: developing an out-of-hospital NIH Stroke Scale. Acad Emerg Med. 1997;4(10):986–990.
   PubMed Web of Science ®Google Scholar
• Harbison J, Hossain O, Jenkinson D, Davis J, Louw SJ, Ford GA. Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke. 2003;34:71–76. doi:10.1161/01.STR.0000044170.46643.5E
   PubMed Web of Science ®Google Scholar
• Lima FO, Furie KL, Frankel MH, et al. The field assessment stroke triage for emergency destination (FAST-ED): a simple and accurate pre-hospital scale to detect large vessel occlusion strokes. Stroke. 2016;47(8):1997–2002.
   Web of Science ®Google Scholar
• De la Ossa NP, Carrera D, Gorchs M, et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke. 2014;45(1):87–91. doi:10.1161/STROKEAHA.113.003071
   PubMed Web of Science ®Google Scholar
• Kidwell CS, Saver JL, Schubert GB, Eckstein M, Starkman S. Design and retrospective analysis of the Los Angeles Prehospital Stroke Screen (LAPSS). Prehosp Emerg Care. 1998;2(4):267–273.
   PubMedGoogle Scholar
• Spilker J, Kongable G, Barch C, et al. Using the NIH Stroke Scale to assess stroke patients. J Neurosci Nurs. 1997;29(6):384–393.
   PubMedGoogle Scholar
• Nor AM, Davis J, Sen B, et al. The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol. 2005;4(11):727–734. doi:10.1016/S1474-4422(05)70201-5
   PubMed Web of Science ®Google Scholar
• Singer OC, Dvorak F, de Rochemont R, Lanfermann H, Sitzer M, Neumann-Haefelin T. A simple 3-item stroke scale: comparison with the National Institutes of Health Stroke Scale and prediction of middle cerebral artery occlusion. Stroke. 2005;36(4):773–776. doi:10.1161/01.STR.0000157591.61322.df
   PubMed Web of Science ®Google Scholar
• Katz BS, McMullan JT, Sucharew H, Adeoye O, Broderick JP. Design and validation of a prehospital scale to predict stroke severity: cincinnati prehospital stroke severity scale. Stroke. 2015;46(6):1508–1512. doi:10.1161/STROKEAHA.115.008804
   PubMed Web of Science ®Google Scholar
• Jauch E, Saver J, Adams H, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stoke Association. Stroke. 2013;44:870–947. doi:10.1161/STR.0b013e318284056a
   PubMed Web of Science ®Google Scholar
• Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49:e233–e234. doi:10.1161/STR.0000000000000158
   PubMed Web of Science ®Google Scholar
• Keenan KJ, Kircher C, McMullan JT. Prehospital prediction of large vessel occlusion in suspected stroke patients. Curr Atheroscler Rep. 2018;20(7):34. doi:10.1007/s11883-018-0734-x
   PubMed Web of Science ®Google Scholar
• Heldner MR, Zubler C, Mattle HP, et al. National Institutes of Health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke. Stroke. 2013;44(4):1153–1157. doi:10.1161/STROKEAHA.111.000604
   PubMed Web of Science ®Google Scholar
• Fischer U, Arnold M, Nedeltchev K, et al. NIHSS score and arteriographic findings in acute ischemic stroke. Stroke. 2005;36(10):2121–2125. doi:10.1161/01.STR.0000182099.04994.fc
   PubMed Web of Science ®Google Scholar
• Glober NK, Sporer KA, Guluma KZ, et al. Acute stroke: current evidence-based recommendations for prehospital care. West J Emerg Med. 2016;17(2):104. doi:10.5811/westjem.2015.12.28995
   PubMedGoogle Scholar
• Mazzucco S, Turri G, Mirandola R, Bovi P, Bisoffi G, Verona Hospital Stroke Study Group. What is still missing in acute-phase treatment of stroke: a prospective observational study. Neurol Sci. 2013;34(4):449–455. doi:10.1007/s10072-012-1024-y
   PubMed Web of Science ®Google Scholar
• CConsoli D, De Falco FA, Lenzi GL, et al. Organizzazione dell’assistenza all’ictus: le Stroke Unit. [Stroke Care Organization: Stroke Units]. Rome: Quaderni del Ministero della Saulte [Ministry of Health Acts]; 2010;2:23. Italian.
   Google Scholar
• Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995;123:A12–3.
   PubMedGoogle Scholar
• Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–269, W64. doi:10.7326/0003-4819-151-4-200908180-00135
   PubMed Web of Science ®Google Scholar
• Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–536. doi:10.7326/0003-4819-155-8-201110180-00009
   PubMed Web of Science ®Google Scholar
• StataCorp. Stata Statistical Software: Release 13. College Station (TX): StataCorp LP; 2013.
   Google Scholar
• Review manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
   Google Scholar
• Asimos AW, Ward S, Brice JH, Rosamond WD, Goldstein LB, Studnek J. Out-of-hospital stroke screen accuracy in a state with an emergency medical services protocol for routing patients to acute stroke centers. Ann Emerg Med. 2014;64(5):509–515. doi:10.1016/j.annemergmed.2014.03.024
   PubMed Web of Science ®Google Scholar
• English SW, Rabinstein AA, Mandrekar J, Klaas JP. Rethinking prehospital stroke notification: assessing utility of emergency medical services impression and cincinnati prehospital stroke scale. J Stroke Cerebrovasc Dis. 2018;27(4):919–925. doi:10.1016/j.jstrokecerebrovasdis.2017.10.036
   PubMed Web of Science ®Google Scholar
• Frendl DM, Strauss DG, Underhill BK, Goldstein LB. Lack of impact of paramedic training and use of the cincinnati prehospital stroke scale on stroke patient identification and on-scene time. Stroke. 2009;40(3):754–756. doi:10.1161/STROKEAHA.108.531285
   PubMed Web of Science ®Google Scholar
• Keenan KJ, Smith WS. The Speech Arm Vision Eyes (SAVE) scale predicts large vessel occlusion stroke as well as more complicated scales. J Neurointerv Surg.
   Web of Science ®Google Scholar
• Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati prehospital stroke scale: reproducibility and validity. Ann Emerg Med. 1999;33(4):373–378.
   PubMed Web of Science ®Google Scholar
• Oostema JA, Konen J, Chassee T, Nasiri M, Reeves MJ. Clinical predictors of accurate prehospital stroke recognition. Stroke. 2015;46(6):1513–1517. doi:10.1161/STROKEAHA.115.008650
   PubMed Web of Science ®Google Scholar
• Ramanujam P, Guluma KZ, Castillo EM, et al. Accuracy of stroke recognition by emergency medical dispatchers andparamedics—San Diego experience. Prehosp Emerg Care. 2008;12(3):307–313. doi:10.1080/10903120802099526
   PubMed Web of Science ®Google Scholar
• Richards CT, Huebinger R, Tataris KL, et al. Cincinnati prehospital stroke scale can identify large vessel occlusion stroke. Prehosp Emerg Care. 2018;22(3):312–318. doi:10.1080/10903127.2017.1387629
   PubMed Web of Science ®Google Scholar
• Studnek JR, Asimos A, Dodds J, Swanson D. Assessing the validity of the Cincinnati prehospital stroke scale and the medic prehospital assessment for code stroke in an urban emergency medical services agency. Prehosp Emerg Care. 2013;17(3):348–353. doi:10.3109/10903127.2013.773113
   PubMed Web of Science ®Google Scholar
• Bray JE, Martin J, Cooper G, Barger B, Bernard S, Bladin C. Paramedic identification of stroke: community validation of the Melbourne ambulance stroke screen. Cerebrovasc Dis. 2005;20(1):28–33. doi:10.1159/000086201
   PubMed Web of Science ®Google Scholar
• Bray JE, Coughlan K, Barger B, Bladin C. Paramedic diagnosis of stroke: examining long-term use of the Melbourne Ambulance Stroke Screen (MASS) in the field. Stroke. 2010;41(7):1363–1366. doi:10.1161/STROKEAHA.109.571836
   PubMed Web of Science ®Google Scholar
• Vanni S, Polidori G, Pepe G, et al. Use of biomarkers in triage of patients with suspected stroke. J Emerg Med. 2011;40(5):499–505. doi:10.1016/j.jemermed.2008.09.028
   PubMed Web of Science ®Google Scholar
• Heldner MR, Hsieh K, Broeg-Morvay A, et al. Clinical prediction of large vessel occlusion in anterior circulation stroke: mission impossible? J Neurol. 2016;263(8):1633–1640. doi:10.1007/s00415-016-8180-6
   PubMed Web of Science ®Google Scholar
• Purrucker JC, Hametner C, Engelbrecht A, Bruckner T. Comparison of stroke recognition and stroke severity scores for stroke detection in a single cohort. J Neurol Neurosurg Psychiatry. 2015;86(9):1021–1028. doi:10.1136/jnnp-2014-309260
   PubMed Web of Science ®Google Scholar
• Maddali A, Razack FA, Cattamanchi S, Ramakrishnan TV. Validation of the cincinnati prehospital stroke scale. J Emerg Trauma Shock. 2018;11(2):111. doi:10.4103/JETS.JETS_8_17
   PubMed Web of Science ®Google Scholar
• Mingfeng H, Zhixin W, Qihong G, Lianda L, Yanbin Y, Jinfang F. Validation of the use of the ROSIER scale in prehospital assessment of stroke. Ann Indian Acad Neurol. 2012;15(3):191. doi:10.4103/0972-2327.99713
   PubMed Web of Science ®Google Scholar
• Bergs J, Sabbe M, Moons P. Prehospital stroke scales in a Belgian prehospital setting: a pilot study. Eur J Emerg Med. 2010;17(1):2–6. doi:10.1097/MEJ.0b013e32831040ec
   PubMed Web of Science ®Google Scholar
• Rudd M, Buck D, Ford GA, Price CI. A systematic review of stroke recognition instruments in hospital and prehospital settings. Emerg Med J. 2016;33(11):818–822. doi:10.1136/emermed-2015-205197
   PubMed Web of Science ®Google Scholar
• Brandler ES, Sharma M, Sinert RH, Levine SR. Prehospital stroke scales in urban environments: a systematic review. Neurology. 2014;82(24):2241–2249. doi:10.1212/WNL.0000000000000523
   PubMed Web of Science ®Google Scholar
• Zhelev Z, Walker G, Henschke N, Fridhandler J, Yip S. Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack. Cochrane Database Syst Rev. 2019;4:CD011427.
   Google Scholar
• Hurwitz AS, Brice JH, Overby BA, Evenson KR. Directed use of the cincinnati prehospital stroke scale by laypersons. Prehosp Emerg Care. 2005;9(3):292–296. doi:10.1080/10903120590962283
   PubMedGoogle Scholar
• Chen S, Sun H, Lei Y, et al. Validation of the Los Angeles pre-hospital stroke screen (LAPSS) in a Chinese urban emergency medical service population. PLoS One. 2013;8(8):e70742. doi:10.1371/journal.pone.0070742
   PubMed Web of Science ®Google Scholar
• Riewe E, Neubauer E, Pfeifer AC, Schiltenwolf M. Predicting persistent back symptoms by psychosocial risk factors: validity criteria for the ÖMPSQ and the HKF-R 10 in Germany. PLoS One. 2016;11(7):e0158850. doi:10.1371/journal.pone.0158850
   PubMed Web of Science ®Google Scholar
• Vidale S, Agostoni E. Prehospital stroke scales and large vessel occlusion: a systematic review. Acta Neurol Scand. 2018;138(1):24–31. doi:10.1111/ane.12908
   PubMed Web of Science ®Google Scholar
• Leeflang M. Systematic reviews and meta-analyses of diagnostic test accuracy. Clin Microbiol Infect. 2014;20(2):105–113. doi:10.1111/1469-0691.12474
   PubMed Web of Science ®Google Scholar
• Pride GL, Fraser JF, Gupta R, et al. Prehospital care delivery and triage of stroke with emergent large vessel occlusion (ELVO): report of the Standards and Guidelines Committee of the Society of Neurointerventional Surgery. J Neurointerv Surg. 2017;9(8):802–812. doi:10.1136/neurintsurg-2016-012699
   PubMed Web of Science ®Google Scholar
• Bogle BM, Asimos AW, Rosamond WD. Regional evaluation of the severity-based stroke triage algorithm for emergency medical services using discrete event simulation. Stroke. 2017;48(10):2827–2835. doi:10.1161/STROKEAHA.117.017905
   PubMed Web of Science ®Google Scholar
• Dozois A, Hampton L, Kingston CW, et al. PLUMBER Study (prevalence of large vessel occlusion strokes in Mecklenburg county emergency response). Stroke. 2017;48(12):3397–3399. doi:10.1161/STROKEAHA.117.018925
   PubMed Web of Science ®Google Scholar
• Van Gaal S, Demchuk A. Clinical and technological approaches to the prehospital diagnosis of large vessel occlusion. Stroke. 2018;49(4):1036–1043. doi:10.1161/STROKEAHA.117.017947
   PubMed Web of Science ®Google Scholar
• Biondi-Zoccai G, editor. Diagnostic Meta-Analysis: A Useful Tool for Clinical Decision-Making. Berlin: Springer International Publishing; 2018.
   Google Scholar
• Li L, Tian J, Tian H, Sun R, Liu Y, Yang K. Quality and transparency of overviews of systematic reviews. J Evid Based Med. 2012;5(3):166–173. doi:10.1111/j.1756-5391.2012.01185.x
   PubMedGoogle Scholar
• Kosack CS, Page AL, Klatser PR. A guide to aid the selection of diagnostic tests. Bull World Health Organ. 2017;95(9):639. doi:10.2471/BLT.16.187468
   PubMed Web of Science ®Google Scholar