Prehospital Stroke Assessment for Large Vessel Occlusions: A Systematic Review

Prehosp Emerg Care. 2018 Mar-Apr;22(2):180-188. doi: 10.1080/10903127.2017.1371263. Epub 2017 Oct 12.


Background and objective: Stroke is the leading cause of disability in the United States and new evidence shows interventional procedures provide better outcomes for large vessel occlusions (LVO). We performed a systematic review of the literature on prehospital stroke scales used to identify LVOs comparing the scales with analysis of the sensitivity, specificity, and predictive values. The goal was to determine if emergency medical services (EMS) are able to accurately identify LVO in the field.

Methods: In this systematic review, multiple databases were searched for articles that addressed our goal. The identified studies were evaluated for their statistical performance of various stroke scales. In addition, we assessed biases that may explain the varying results reported.

Results: Eight studies encompassing 6787 patients were included in our systematic review. Of the 8 studies, 6 were retrospective studies, 1 was a prospective cohort, and 1 was a prospective observational study. Sensitivities of the studies ranged from 49% to 91% while specificity of the studies varied from 40% to 94%.

Conclusion: At this time, further evaluations must be done in the prehospital setting to determine the ease of use and true sensitivity and specificity of these scales in identifying LVOs.

Keywords: acute; review; stroke; stroke score; systematic.

Publication types

  • Systematic Review

MeSH terms

  • Arterial Occlusive Diseases / complications*
  • Brain Ischemia / physiopathology
  • Cohort Studies
  • Emergency Medical Services / methods*
  • Humans
  • Prospective Studies
  • Retrospective Studies
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Stroke / drug therapy*
  • Stroke / etiology*