Prehospital stroke scales and large vessel occlusion: A systematic review

Acta Neurol Scand. 2018 Jul;138(1):24-31. doi: 10.1111/ane.12908. Epub 2018 Feb 11.


Background and purpose: Time sensitivity for pharmacological and mechanical arterial recanalization in acute ischemic stroke influences the choice of the reference hospital. The accurate selection and identification of patients with high probability of a large vessel occlusion (LVO) in the prehospital setting improve the rationalization of the transport in the more suitable centers. Aim of this analysis was to determine the diagnostic accuracy of prehospital stroke scales detecting LVO.

Material and methods: Studies were searched into MEDLINE, EMBASE, and CINHAL databases between January 1990 and September 2017. Principal measurements of the meta-analysis were the overall accuracy level, sensitivity, and specificity of prehospital stroke scales.

Results: Nineteen scoring systems were included in the analysis coming from 13 studies. A total of 9824 patients were considered. Although a higher heterogeneity was observed in the analysis, three scores showed better results in predicting a LVO (the stroke Vision, Aphasia, Neglect assessment, the National Institute of Health Stroke scale and the Los Angeles Motor Scale). We observed significant differences of overall accuracy only for scores including hemineglect as cortical neurological sign (P < .05).

Conclusions: This meta-analysis suggests that some prehospital scoring systems including cortical signs showed better accuracy to predict stroke due to LVO. However, the assessment of these signs could be difficult to investigate by paramedics and personnel of Emergency Medical Services, and for this reason, further prospective evaluations are needed.

Keywords: large vessel occlusion; meta-analysis; prehospital stroke scale; thrombolysis.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Cerebrovascular Disorders / complications
  • Cerebrovascular Disorders / diagnosis*
  • Emergency Medical Services
  • Female
  • Hospital Units
  • Humans
  • Male
  • Severity of Illness Index*
  • Stroke / diagnosis*
  • Stroke / etiology