TY - JOUR
T1 - Characteristics of patients who had a stroke not initially identified during emergency prehospital assessment
T2 - A systematic review
AU - Jones, Stephanie P.
AU - Bray, Janet E.
AU - Gibson, Josephine M.E.
AU - McClelland, Graham
AU - Miller, Colette
AU - Price, Chris I.
AU - Watkins, Caroline L.
N1 - Funding Information: Funding for this review was received from the The University of Central Lancashire Research Institute For Global Health and Well-being (LIFE). JEB is supported by the Heart Foundation of Australia and the National Health and Medical Research Council (NHMRC) Prehospital Care Centre of Research Excellence.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Background Around 25% of patients who had a stroke do not present with typical € face, arm, speech' symptoms at onset, and are challenging for emergency medical services (EMS) to identify. The aim of this systematic review was to identify the characteristics of acute stroke presentations associated with inaccurate EMS identification (false negatives). Method We performed a systematic search of MEDLINE, EMBASE, CINAHL and PubMed from 1995 to August 2020 using key terms: stroke, EMS, paramedics, identification and assessment. Studies included: patients who had a stroke or patient records; ≥18 years; any stroke type; prehospital assessment undertaken by health professionals including paramedics or technicians; data reported on prehospital diagnostic accuracy and/or presenting symptoms. Data were extracted and study quality assessed by two researchers using the Quality Assessment of Diagnostic Accuracy Studies V.2 tool. Results Of 845 studies initially identified, 21 observational studies met the inclusion criteria. Of the 6934 stroke and Transient Ischaemic Attack patients included, there were 1774 (26%) false negative patients (range from 4 (2%) to 247 (52%)). Commonly documented symptoms in false negative cases were speech problems (n=107; 13%-28%), nausea/vomiting (n=94; 8%-38%), dizziness (n=86; 23%-27%), changes in mental status (n=51; 8%-25%) and visual disturbance/impairment (n=43; 13%-28%). Conclusion Speech problems and posterior circulation symptoms were the most commonly documented symptoms among stroke presentations that were not correctly identified by EMS (false negatives). However, the addition of further symptoms to stroke screening tools requires valuation of subsequent sensitivity and specificity, training needs and possible overuse of high priority resources.
AB - Background Around 25% of patients who had a stroke do not present with typical € face, arm, speech' symptoms at onset, and are challenging for emergency medical services (EMS) to identify. The aim of this systematic review was to identify the characteristics of acute stroke presentations associated with inaccurate EMS identification (false negatives). Method We performed a systematic search of MEDLINE, EMBASE, CINAHL and PubMed from 1995 to August 2020 using key terms: stroke, EMS, paramedics, identification and assessment. Studies included: patients who had a stroke or patient records; ≥18 years; any stroke type; prehospital assessment undertaken by health professionals including paramedics or technicians; data reported on prehospital diagnostic accuracy and/or presenting symptoms. Data were extracted and study quality assessed by two researchers using the Quality Assessment of Diagnostic Accuracy Studies V.2 tool. Results Of 845 studies initially identified, 21 observational studies met the inclusion criteria. Of the 6934 stroke and Transient Ischaemic Attack patients included, there were 1774 (26%) false negative patients (range from 4 (2%) to 247 (52%)). Commonly documented symptoms in false negative cases were speech problems (n=107; 13%-28%), nausea/vomiting (n=94; 8%-38%), dizziness (n=86; 23%-27%), changes in mental status (n=51; 8%-25%) and visual disturbance/impairment (n=43; 13%-28%). Conclusion Speech problems and posterior circulation symptoms were the most commonly documented symptoms among stroke presentations that were not correctly identified by EMS (false negatives). However, the addition of further symptoms to stroke screening tools requires valuation of subsequent sensitivity and specificity, training needs and possible overuse of high priority resources.
KW - diagnosis
KW - pre-hospital
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85101229257&partnerID=8YFLogxK
U2 - 10.1136/emermed-2020-209607
DO - 10.1136/emermed-2020-209607
M3 - Review article
C2 - 33608393
AN - SCOPUS:85101229257
SN - 1472-0205
VL - 38
SP - 387
EP - 393
JO - Emergency Medicine Journal
JF - Emergency Medicine Journal
IS - 5
ER -