The role of the Cincinnati Prehospital Stroke Scale in the emergency department: evidence from a systematic review and meta-analysis.
diagnostic accuracy
emergency department
emergency medical services
healthcare
stroke
triage
Journal
Open access emergency medicine : OAEM
ISSN: 1179-1500
Titre abrégé: Open Access Emerg Med
Pays: New Zealand
ID NLM: 101570796
Informations de publication
Date de publication:
2019
2019
Historique:
received:
15
03
2019
accepted:
21
06
2019
entrez:
15
8
2019
pubmed:
15
8
2019
medline:
15
8
2019
Statut:
epublish
Résumé
Stroke is one of the leading causes of morbidity, disability, and mortality in high-income countries. Early prehospital stroke recognition plays a fundamental role, because most clinical decisions should be made within the first hours after onset of symptoms. The Cincinnati Prehospital Stroke Scale (CPSS) is a validated screening tool whose utilization is suggested during triage. The aim of this study is to review the role of the CPSS by assessing its sensitivity and specificity in prehospital and hospital settings. A systematic review and a meta-analysis of the literature reporting the CPSS sensitivity and specificity among patients suspected of stroke were undertaken. Electronic databases were searched up to December 2018, and the quality assessment was carried out by using the Revised Quality Assessment of Diagnostic Accuracy Studies -2 (QUADAS-2). Eleven studies were included in the meta-analysis. Results showed an overall sensitivity of 82.46% (95% confidence interval [CI] 74.83-88.09%) and specificity of 56.95% (95% CI 41.78-70.92). No significant differences were found in terms of sensitivity when CPSS was performed by physicians (80.11%, 95% CI 66.14-89.25%) or non-physicians (81.11%, 95% CI 69.78-88.87%). However, administration by physicians resulted in higher specificity (73.57%, 95% CI 65.78-80.12%) when compared to administration by non-physicians (50.07%, 95% CI 31.54-68.58%). Prospective studies showed higher specificity 71.61% (95% CI 61.12-80.18%) and sensitivity 86.82% (95% CI 74.72-93.63) when compared to retrospective studies which showed specificity of 33.37% (95% CI 22.79-45.94%) and sensitivity of 78.52% (95% CI 75.08-81.60). The CPSS is a standardized and easy-to-use stroke screening tool whose implementation in emergency systems protocols, along with proper and consistent coordination with local, regional, and state agencies, medical authorities and local experts are suggested.
Identifiants
pubmed: 31410071
doi: 10.2147/OAEM.S178544
pii: 178544
pmc: PMC6646799
doi:
Types de publication
Journal Article
Langues
eng
Pagination
147-159Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
Références
Ann Emerg Med. 1999 Apr;33(4):373-8
pubmed: 10092713
Stroke. 2003 Jan;34(1):71-6
pubmed: 12511753
Stroke. 2005 Apr;36(4):773-6
pubmed: 15731478
Cerebrovasc Dis. 2005;20(1):28-33
pubmed: 15942171
Prehosp Emerg Care. 2005 Jul-Sep;9(3):292-6
pubmed: 16147478
Stroke. 2005 Oct;36(10):2121-5
pubmed: 16151026
Lancet Neurol. 2005 Nov;4(11):727-34
pubmed: 16239179
Stroke. 2006 Jan;37(1):263-6
pubmed: 16339467
Prehosp Emerg Care. 2008 Jul-Sep;12(3):307-13
pubmed: 18584497
Stroke. 2009 Mar;40(3):754-6
pubmed: 19118240
J Emerg Med. 2011 May;40(5):499-505
pubmed: 19217237
J Cardiovasc Surg (Torino). 2009 Apr;50(2):171-82
pubmed: 19329914
Eur J Emerg Med. 2010 Feb;17(1):2-6
pubmed: 19550343
Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
pubmed: 19622511
Lancet. 2010 May 15;375(9727):1695-703
pubmed: 20472172
Stroke. 2010 Jul;41(7):1363-6
pubmed: 20538702
Ann Intern Med. 2011 Oct 18;155(8):529-36
pubmed: 22007046
Neurol Sci. 2013 Apr;34(4):449-55
pubmed: 22466805
Lancet. 2012 Jun 23;379(9834):2364-72
pubmed: 22632907
Ann Indian Acad Neurol. 2012 Jul;15(3):191-5
pubmed: 22919191
Stroke. 2013 Mar;44(3):870-947
pubmed: 23370205
Stroke. 2013 Apr;44(4):1153-7
pubmed: 23471266
Prehosp Emerg Care. 2013 Jul-Sep;17(3):348-53
pubmed: 23495755
J Evid Based Med. 2012 Aug;5(3):166-73
pubmed: 23672223
JAMA. 2013 Aug 14;310(6):591-608
pubmed: 23842577
PLoS One. 2013 Aug 07;8(8):e70742
pubmed: 23950994
Clin Microbiol Infect. 2014 Feb;20(2):105-13
pubmed: 24274632
Stroke. 2014 Jan;45(1):87-91
pubmed: 24281224
Pak J Med Sci. 2013 Jan;29(1):181-6
pubmed: 24353536
Neurology. 2014 Jan 28;82(4):340-50
pubmed: 24363134
Ann Emerg Med. 2014 Nov;64(5):509-15
pubmed: 24746847
Neurology. 2014 Jun 17;82(24):2241-9
pubmed: 24850487
JAMA. 2014 Jul 16;312(3):259-68
pubmed: 25027141
J Neurol Neurosurg Psychiatry. 2015 Sep;86(9):1021-8
pubmed: 25466259
Stroke. 2015 Jun;46(6):1508-12
pubmed: 25899242
Stroke. 2015 Jun;46(6):1513-7
pubmed: 25922507
Emerg Med J. 2016 Nov;33(11):818-822
pubmed: 26574548
West J Emerg Med. 2016 Mar;17(2):104-28
pubmed: 26973735
J Neurol. 2016 Aug;263(8):1633-40
pubmed: 27272907
Stroke. 2016 Aug;47(8):1997-2002
pubmed: 27364531
PLoS One. 2016 Jul 21;11(7):e0158850
pubmed: 27442020
J Neurointerv Surg. 2017 Aug;9(8):802-812
pubmed: 27707873
Bull World Health Organ. 2017 Sep 1;95(9):639-645
pubmed: 28867844
Stroke. 2017 Oct;48(10):2827-2835
pubmed: 28916666
Lancet. 2017 Sep 16;390(10100):1211-1259
pubmed: 28919117
Stroke. 2017 Dec;48(12):3397-3399
pubmed: 29070716
J Stroke Cerebrovasc Dis. 2018 Apr;27(4):919-925
pubmed: 29217362
Prehosp Emerg Care. 2018 May-Jun;22(3):312-318
pubmed: 29297717
Stroke. 2018 Mar;49(3):e46-e110
pubmed: 29367334
Circulation. 2018 Mar 20;137(12):e67-e492
pubmed: 29386200
Acta Neurol Scand. 2018 Jul;138(1):24-31
pubmed: 29430622
Stroke. 2018 Apr;49(4):1036-1043
pubmed: 29540610
Curr Atheroscler Rep. 2018 May 21;20(7):34
pubmed: 29781051
J Emerg Trauma Shock. 2018 Apr-Jun;11(2):111-114
pubmed: 29937640
J Neurointerv Surg. 2019 Jul;11(7):659-663
pubmed: 30514735
Cochrane Database Syst Rev. 2019 Apr 09;4:CD011427
pubmed: 30964558
ACP J Club. 1995 Nov-Dec;123(3):A12-3
pubmed: 7582737
Acad Emerg Med. 1997 Oct;4(10):986-90
pubmed: 9332632
J Neurosci Nurs. 1997 Dec;29(6):384-92
pubmed: 9479660
Prehosp Emerg Care. 1998 Oct-Dec;2(4):267-73
pubmed: 9799012