A multi-center diagnostic accuracy study on nine Prehospital Stroke Screening Scales

Abstract

Background: Stroke is one of the most common debilitating diseases. Although effective treatment is available, but a golden-time has been defined in this regard. Therefore, prompt action is needed to identify patients with stroke as soon as possible, even in the pre-hospital stage. In recent years, several clinical scales have been introduced for this purpose. We performed the present study to examine the accuracy of 9 clinical scales in terms of stroke diagnosis.Methods: This multi-center diagnostic accuracy study has been conducted during 2019. All patients older than 18 years, presenting to ED, who had undergone brain magnetic resonance imaging (MRI) due to suspicion of stroke were eligible. All data were gathered in a pre-designed checklist consisting of 3 sections, using the clinical profiles of the patients. The first section of the checklist included baseline characteristics and demographic data. The second part included physical examination findings of 19 items related to the 9 scales. The third part was dedicated to the final diagnosis based on the interpretation of brain magnetic resonance imaging (MRI), which was considered the gold standard method for acute ischemic stroke (AIS) diagnosis in the current study.Results: Data of 805 patients suspected to stroke were analyzed. Of all, 463 (57.5%) patients were male. Participants’ age was between 6 and 95 years and their mean age was 66.9 years (SD=13.9). Off all the enrolled patients, 562 patients (69.8%) had acute ischemic stroke. The accuracy of screening tests was between 63.0% and 84.4%. Their sensitivity and specificity were between 50.2% to 95.7% and 46.5% to 92.2%, respectively. Among all the screening tests, RACE had the lowest sensitivity (50.2%) and MedPACS had the highest (95.7%). In addition, PreHAST had the lowest specificity (46.5%) and RACE had the highest (92.2%).Conclusion: Based on the findings of the present study, highly sensitive tests that can be used in this regard are CPSS, FAST and MEDPACS, all of which have about 95% sensitivity. On the other hand, none of the studied tools were desirable (specificity above 95%) in any of the examined cut-offs.