Emergency Medical Services dispatcher recognition of stroke: A systematic review.

Stroke treatments are time-sensitive, and thus early and correct recognition of stroke by Emergency Medical Services is essential for outcomes. This is particularly important with the adaption of mobile stroke units. In this systematic review, we therefore aimed to provide a comprehensive overview of Emergency Medical Services dispatcher recognition of stroke. The review was registered on PROSPERO and the PRISMA guidelines were applied. We searched PubMed, Embase, and Cochrane Review Library. Screening and data extraction were performed by two observers. Risk of bias was assessed using the QUADAS-2 instrument. Of 1200 papers screened, 24 fulfilled the inclusion criteria. Data on sensitivity was reported in 22 papers and varied from 17.9% to 83.0%. Positive predictive values were reported in 12 papers and ranged from 24.0% to 87.7%. Seven papers reported specificity, which ranged from 20.0% to 99.1%. Six papers reported negative predictive value, ranging from 28.0% to 99.4%. In general, the risk of bias was low. Stroke recognition by dispatchers varied greatly, but overall many patients with stroke are not recognised, despite the initiatives taken to improve stroke literacy. The available data are of high quality, however Asian, African, and South American populations are underrepresented. While the data are heterogenous, this review can serve as a reference for future research in emergency medical dispatcher stroke recognition and initiatives to improve prehospital stroke recognition.

Déclaration de conflit d'intérêts

Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: HC is Chair of Action Plan for Stroke in Europe Implementation, Co-chair Scientific Stroke Panel, EAN and Senior Guest Editor: AHA Stroke. She has received grants from the Velux foundation, Tværsfonden, Helsefonden, the Hartmann Brothers Foundation, The Lundbeck Foundation, and the Novo Nordic Foundation. HC also co-authored the paper by Viereck et al. included in this review. HC has received honoraria from Bayer and BMS and receives royalties from Gyldendal publishing. CK has received grants from the Novo Nordic Foundation, Lundbeck Foundation and Trygfonden and is Vicechair (since 2023 Chair) of the Danish Resuscitation Council (unpaid) and the Vicechair of Danish Stroke Society (unpaid). JW, BHH, MVS, HCC and SNB have no conflicting interest to declare.