The role of the Cincinnati Prehospital Stroke Scale in the emergency department: evidence from a systematic review and meta-analysis
Received 15 March 2019
Accepted for publication 21 June 2019
Published 17 July 2019 Volume 2019:11 Pages 147—159
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Hans-Christoph Pape
A De Luca,1,* M Mariani,2,* MT Riccardi,2 G Damiani2,3
1Istituti Fisioterapici Ospitalieri, Rome, Italy; 2Università Cattolica del Sacro Cuore, Rome, Italy; 3Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
*These authors contributed equally to this work
Introduction: Stroke is one of the leading causes of morbidity, disability, and mortality in high-income countries. Early prehospital stroke recognition plays a fundamental role, because most clinical decisions should be made within the first hours after onset of symptoms. The Cincinnati Prehospital Stroke Scale (CPSS) is a validated screening tool whose utilization is suggested during triage. The aim of this study is to review the role of the CPSS by assessing its sensitivity and specificity in prehospital and hospital settings.
Methods: A systematic review and a meta-analysis of the literature reporting the CPSS sensitivity and specificity among patients suspected of stroke were undertaken. Electronic databases were searched up to December 2018, and the quality assessment was carried out by using the Revised Quality Assessment of Diagnostic Accuracy Studies −2 (QUADAS-2).
Results: Eleven studies were included in the meta-analysis. Results showed an overall sensitivity of 82.46% (95% confidence interval [CI] 74.83–88.09%) and specificity of 56.95% (95% CI 41.78–70.92). No significant differences were found in terms of sensitivity when CPSS was performed by physicians (80.11%, 95% CI 66.14–89.25%) or non-physicians (81.11%, 95% CI 69.78–88.87%). However, administration by physicians resulted in higher specificity (73.57%, 95% CI 65.78–80.12%) when compared to administration by non-physicians (50.07%, 95% CI 31.54–68.58%). Prospective studies showed higher specificity 71.61% (95% CI 61.12–80.18%) and sensitivity 86.82% (95% CI 74.72–93.63) when compared to retrospective studies which showed specificity of 33.37% (95% CI 22.79–45.94%) and sensitivity of 78.52% (95% CI 75.08–81.60).
Conclusions: The CPSS is a standardized and easy-to-use stroke screening tool whose implementation in emergency systems protocols, along with proper and consistent coordination with local, regional, and state agencies, medical authorities and local experts are suggested.
Keywords: stroke, triage, healthcare, diagnostic accuracy, emergency medical services, emergency department
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]