The value of predictive instruments in the screening of acute stroke: an umbrella review on previous systematic reviews
-
Alireza Baratloo
,
Mobin Mohamadi
,
Mohammad Mohammadi
,
Amirmohammad Toloui
,
Arian Madani Neishaboori
,
Seyedeh Niloufar Rafiei Alavi
,
Ali Nahiyeh
,
Mahmoud Yousefifard
Abstract
Objective: Although various predictive instruments have been introduced for early stroke diagnosis, there is no consensus on their performance. Therefore, we decided to assess the value of predictive instruments in the detection of stroke by conducting an umbrella review. Methods: A search was performed in the Medline, Embase, Scopus and Web of Science databases by the end of August 2021 for systematic reviews and meta-analyses. Original articles included in the systematic reviews were retrieved, summarized and pooled sensitivity, specificity and diagnostic odds ratio were calculated. The level of evidence was divided into five groups: convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV) and non-significant. Results: The value of 33 predictive instruments was evaluated. The sample size included in these scoring systems’ assessments varied between 182 and 47072 patients. The level of evidence was class I in one tool, class II in 18 tools, class III in 2 tools, class IV in 11 tools, and non-significant in one tool. Apart from Med PACS, which had a low diagnostic value, other tools appeared to be able to detect a stroke. The optimum performance for diagnosis of stroke was for ROSIER, NIHSS, PASS, FAST, LAMS, RACE and CPSS. Conclusion: Convincing to suggestive evidence shows that ROSIER, NIHSS, PASS, FAST, LAMS, RACE and CPSS have the optimum performance in identifying stroke. Since ROSIER’s calculation is simple and has the highest sensitivity and specificity among those predictive instruments, it is recommended for stroke diagnosis in pre-hospital and in-hospital settings.
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7. Simonsen CZ, Yoo AJ, Rasmussen M, Sorensen KE, Leslie-Mazwi T, Andersen G, et al. Magnetic Resonance Imaging Selection for Endovascular Stroke Therapy: Workflow in the GOLIATH Trial. Stroke. 2018;49(6):1402-6.
8. Brandler ES, Sharma M, Sinert RH, Levine SR. Prehospital stroke scales in urban environments: a systematic review. Neurology. 2014;82(24):2241-9.
9. Smith EE, Kent DM, Bulsara KR, Leung LY, Lichtman JH, Reeves MJ, et al. Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2018;49(3):e111-22.
10. Vidale S, Agostoni E. Prehospital stroke scales and large vessel occlusion: A systematic review Acta Neurol Scand. 2018;138(1):24-31.
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14. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.
15. Ioannidis JP, Trikalinos TA. An exploratory test for an excess of significant findings. Clin Trials. 2007;4(3):245-53.
16. Radua J, Ramella‐Cravaro V, Ioannidis JP, Reichenberg A, Phiphopthatsanee N, Amir T, et al. What causes psychosis? An umbrella review of risk and protective factors. World Psychiatry. 2018;17(1):49-66.
17. Antipova D, Eadie L, Macaden A, Wilson P. Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review. BMC Emerg Med. 2019;19(1):49.
18. De Luca A, Mariani M, Riccardi MT, Damiani G. The role of the Cincinnati Prehospital Stroke scale in the emergency department: Evidence from a systematic review and meta-analysis. Open Access Emerg Med. 2019;11:147-59.
19. Han F, Zuo C, Zheng G. A systematic review and meta-analysis to evaluate the diagnostic accuracy of recognition of stroke in the emergency department (ROSIER) scale. BMC Neurol. 2020;20(1):304.
20. Krebs W, Sharkey-Toppen TP, Cheek F, Cortez E, Larrimore A, Keseg D, et al. Prehospital Stroke Assessment for Large Vessel Occlusions: A Systematic Review. Prehosp Emerg Care. 2018;22(2):180-8.
21. Loudon W, Wong A, Disney M, Tippett V, Lead BN. Validated pre-hospital stroke scales to predict large vessel occlusion: A systematic review. Australas J Paramed. 2019;16.
22. Meyran D, Cassan P, Avau B, Singletary E, Zideman DA. Stroke Recognition for First Aid Providers: A Systematic Review and Meta-Analysis. Cureus. 2020;12(11):e11386.
23. Oostema JA, Carle T, Talia N, Reeves M. Dispatcher Stroke Recognition Using a Stroke Screening Tool: A Systematic Review. Cerebrovasc Dis. 2016;42(5-6):370-7.
24. Rudd M, Buck D, Ford GA, Price CI. A systematic review of stroke recognition instruments in hospital and prehospital settings. Emerg Med J. 2016;33(11):818-22.
25. Devillé WL, Buntinx F, Bouter LM, Montori VM, de Vet HCW, van der Windt DAWM, et al. Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol. 2002;2:9.
26. Karimi S, Heydari F, Mirbaha S, Elfil M, Baratloo A. Accuracy of prehospital ambulance stroke test in terms of diagnosis of patients with acute ischemic stroke: A multi-center study. Curr J Neurol. 2020;19(4):196-9.
27. Saberian P, Tavakoli N, Hasani-Sharamin P, Aghili M, Baratloo A. Accuracy of stroke diagnosis using FAST (Face, Arm, Speech, Time) tool by emergency medical service dispatchers and technicians and its impact on transport time. Arch Neurosci. 2020;7(1): e98691.
28. Zangi M, Karimi S, Mirbaha S, Sotoodehnia M, Rasooli F, Baratloo A. The validity of recognition of stroke in the emergency room (ROSIER) scale in the diagnosis of Iranian patients with acute ischemic stroke in the emergency department. Turk J Emerg Med. 2021;21(1):1-5.
29. Birnbaum L, Wampler D, Shadman A, de Leonni Stanonik M, Patterson M, Kidd E, et al. Paramedic utilization of Vision, Aphasia, Neglect (VAN) stroke severity scale in the prehospital setting predicts emergent large vessel occlusion stroke. J Neurointerv Surg. 2021;13(6):505-8.
30. Crowe RP, Myers JB, Fernandez AR, Bourn S, McMullan JT. The cincinnati prehospital stroke scale compared to stroke severity tools for large vessel occlusion stroke prediction. Prehosp Emerg Care. 2021;25(1):67-75.
2. Saadat S, Yousefifard M, Asady H, Moghadas Jafari A, Fayaz M, Hosseini M. The Most Important Causes of Death in Iranian Population; a Retrospective Cohort Study. Emergency. 2015;3(1):16-21.
3. Gorelick AR, Gorelick PB, Sloan EP. Emergency department evaluation and management of stroke: acute assessment, stroke teams and care pathways. Neurol Clin. 2008;26(4):923-42, viii.
4. Campbell BCV, Donnan GA, Mitchell PJ, Davis SM. Endovascular thrombectomy for stroke: current best practice and future goals. Stroke Vasc Neurol. 2016;1(1):16-22.
5. Zaidat OO, Haussen DC, Hassan AE, Jadhav AP, Mehta BP, Mokin M, et al. Impact of Stent Retriever Size on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry. Stroke. 2019;50(2):441-7.
6. Broocks G, Flottmann F, Hanning U, Schon G, Sporns P, Minnerup J, et al. Impact of endovascular recanalization on quantitative lesion water uptake in ischemic anterior circulation strokes. J Cereb Blood Flow Metab. 2020;40(2):437-45.
7. Simonsen CZ, Yoo AJ, Rasmussen M, Sorensen KE, Leslie-Mazwi T, Andersen G, et al. Magnetic Resonance Imaging Selection for Endovascular Stroke Therapy: Workflow in the GOLIATH Trial. Stroke. 2018;49(6):1402-6.
8. Brandler ES, Sharma M, Sinert RH, Levine SR. Prehospital stroke scales in urban environments: a systematic review. Neurology. 2014;82(24):2241-9.
9. Smith EE, Kent DM, Bulsara KR, Leung LY, Lichtman JH, Reeves MJ, et al. Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2018;49(3):e111-22.
10. Vidale S, Agostoni E. Prehospital stroke scales and large vessel occlusion: A systematic review Acta Neurol Scand. 2018;138(1):24-31.
11. Saberian P, Rafemanesh H, Heydari F, Mirbaha S, Karimi S, Baratloo A. A Multicenter Diagnostic Accuracy Study on Prehospital Stroke Screening Scales. Arch Iran Med. 2021;24(6):453-60.
12. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10:89.
13. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. 2000;283(15):2008-12.
14. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.
15. Ioannidis JP, Trikalinos TA. An exploratory test for an excess of significant findings. Clin Trials. 2007;4(3):245-53.
16. Radua J, Ramella‐Cravaro V, Ioannidis JP, Reichenberg A, Phiphopthatsanee N, Amir T, et al. What causes psychosis? An umbrella review of risk and protective factors. World Psychiatry. 2018;17(1):49-66.
17. Antipova D, Eadie L, Macaden A, Wilson P. Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review. BMC Emerg Med. 2019;19(1):49.
18. De Luca A, Mariani M, Riccardi MT, Damiani G. The role of the Cincinnati Prehospital Stroke scale in the emergency department: Evidence from a systematic review and meta-analysis. Open Access Emerg Med. 2019;11:147-59.
19. Han F, Zuo C, Zheng G. A systematic review and meta-analysis to evaluate the diagnostic accuracy of recognition of stroke in the emergency department (ROSIER) scale. BMC Neurol. 2020;20(1):304.
20. Krebs W, Sharkey-Toppen TP, Cheek F, Cortez E, Larrimore A, Keseg D, et al. Prehospital Stroke Assessment for Large Vessel Occlusions: A Systematic Review. Prehosp Emerg Care. 2018;22(2):180-8.
21. Loudon W, Wong A, Disney M, Tippett V, Lead BN. Validated pre-hospital stroke scales to predict large vessel occlusion: A systematic review. Australas J Paramed. 2019;16.
22. Meyran D, Cassan P, Avau B, Singletary E, Zideman DA. Stroke Recognition for First Aid Providers: A Systematic Review and Meta-Analysis. Cureus. 2020;12(11):e11386.
23. Oostema JA, Carle T, Talia N, Reeves M. Dispatcher Stroke Recognition Using a Stroke Screening Tool: A Systematic Review. Cerebrovasc Dis. 2016;42(5-6):370-7.
24. Rudd M, Buck D, Ford GA, Price CI. A systematic review of stroke recognition instruments in hospital and prehospital settings. Emerg Med J. 2016;33(11):818-22.
25. Devillé WL, Buntinx F, Bouter LM, Montori VM, de Vet HCW, van der Windt DAWM, et al. Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol. 2002;2:9.
26. Karimi S, Heydari F, Mirbaha S, Elfil M, Baratloo A. Accuracy of prehospital ambulance stroke test in terms of diagnosis of patients with acute ischemic stroke: A multi-center study. Curr J Neurol. 2020;19(4):196-9.
27. Saberian P, Tavakoli N, Hasani-Sharamin P, Aghili M, Baratloo A. Accuracy of stroke diagnosis using FAST (Face, Arm, Speech, Time) tool by emergency medical service dispatchers and technicians and its impact on transport time. Arch Neurosci. 2020;7(1): e98691.
28. Zangi M, Karimi S, Mirbaha S, Sotoodehnia M, Rasooli F, Baratloo A. The validity of recognition of stroke in the emergency room (ROSIER) scale in the diagnosis of Iranian patients with acute ischemic stroke in the emergency department. Turk J Emerg Med. 2021;21(1):1-5.
29. Birnbaum L, Wampler D, Shadman A, de Leonni Stanonik M, Patterson M, Kidd E, et al. Paramedic utilization of Vision, Aphasia, Neglect (VAN) stroke severity scale in the prehospital setting predicts emergent large vessel occlusion stroke. J Neurointerv Surg. 2021;13(6):505-8.
30. Crowe RP, Myers JB, Fernandez AR, Bourn S, McMullan JT. The cincinnati prehospital stroke scale compared to stroke severity tools for large vessel occlusion stroke prediction. Prehosp Emerg Care. 2021;25(1):67-75.
| Files | ||
| Issue | Vol 6 No 3 (2022): Summer (July) | |
| Section | Review article | |
| DOI | 10.18502/fem.v6i3.9400 | |
| Keywords | ||
| Decision Support Techniques Diagnosis Emergency Medical Service Stroke | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Baratloo A, Mohamadi M, Mohammadi M, Toloui A, Madani Neishaboori A, Rafiei Alavi SN, Nahiyeh A, Yousefifard M. The value of predictive instruments in the screening of acute stroke: an umbrella review on previous systematic reviews. Front Emerg Med. 2022;6(3):e38.
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