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Out-of-hospital stroke screen accuracy in a state with an emergency medical services protocol for routing patients to acute stroke centers.

Publication ,  Journal Article
Asimos, AW; Ward, S; Brice, JH; Rosamond, WD; Goldstein, LB; Studnek, J
Published in: Ann Emerg Med
November 2014

STUDY OBJECTIVE: Emergency medical services (EMS) protocols, which route patients with suspected stroke to stroke centers, rely on the use of accurate stroke screening criteria. Our goal is to conduct a statewide EMS agency evaluation of the accuracies of the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS) for identifying acute stroke patients. METHODS: We conducted a retrospective study in North Carolina by linking a statewide EMS database to a hospital database, using validated deterministic matching. We compared EMS CPSS or LAPSS results (positive or negative) to the emergency department diagnosis International Classification of Diseases, Ninth Revision codes. We calculated sensitivity, specificity, and positive and negative likelihood ratios for the EMS diagnosis of stroke, using each screening tool. RESULTS: We included 1,217 CPSS patients and 1,225 LAPSS patients evaluated by 117 EMS agencies from 94 North Carolina counties. Most EMS agencies contributing data had high annual patient volumes and were governmental agencies with nonvolunteer, emergency medical technician-paramedic service level providers. The CPSS had a sensitivity of 80% (95% confidence interval [CI] 77% to 83%) versus 74% (95% CI 71% to 77%) for the LAPSS. Each had a specificity of 48% (CPSS 95% CI 44% to 52%; LAPSS 95% CI 43% to 53%). CONCLUSION: The CPSS and LAPSS had similar test characteristics, with each having only limited specificity. Development of stroke screening scales that optimize both sensitivity and specificity is required if these are to be used to determine transport diversion to acute stroke centers.

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Published In

Ann Emerg Med

DOI

EISSN

1097-6760

Publication Date

November 2014

Volume

64

Issue

5

Start / End Page

509 / 515

Location

United States

Related Subject Headings

  • Stroke
  • Sensitivity and Specificity
  • Outcome and Process Assessment, Health Care
  • North Carolina
  • Male
  • Humans
  • Female
  • Emergency Medical Services
  • Emergency & Critical Care Medicine
  • Decision Support Techniques
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Asimos, A. W., Ward, S., Brice, J. H., Rosamond, W. D., Goldstein, L. B., & Studnek, J. (2014). 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, 64(5), 509–515. https://doi.org/10.1016/j.annemergmed.2014.03.024
Asimos, Andrew W., Shana Ward, Jane H. Brice, Wayne D. Rosamond, Larry B. Goldstein, and Jonathan Studnek. “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 64, no. 5 (November 2014): 509–15. https://doi.org/10.1016/j.annemergmed.2014.03.024.
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 Nov;64(5):509–15.
Asimos, Andrew W., et al. “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, vol. 64, no. 5, Nov. 2014, pp. 509–15. Pubmed, doi:10.1016/j.annemergmed.2014.03.024.
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 Nov;64(5):509–515.
Journal cover image

Published In

Ann Emerg Med

DOI

EISSN

1097-6760

Publication Date

November 2014

Volume

64

Issue

5

Start / End Page

509 / 515

Location

United States

Related Subject Headings

  • Stroke
  • Sensitivity and Specificity
  • Outcome and Process Assessment, Health Care
  • North Carolina
  • Male
  • Humans
  • Female
  • Emergency Medical Services
  • Emergency & Critical Care Medicine
  • Decision Support Techniques