Oostema John Adam, Carle Trevor, Talia Nadine, Reeves Mathew
Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, Mich., USA.
Cerebrovasc Dis. 2016;42(5-6):370-377. doi: 10.1159/000447459. Epub 2016 Jun 28.
Emergency dispatchers represent the first point of contact for patients activating an acute stroke response. Accurate dispatcher stroke recognition is associated with faster emergency medical services response time; however, stroke is often unrecognized during initial emergency calls. Stroke screening tools such as the Cincinnati Prehospital Stroke Scale have been shown to improve on-scene stroke recognition and thus have been proposed as a means to improve dispatcher accuracy. We conducted a systematic review of the accuracy of emergency dispatcher stroke recognition when employing stroke screening tools.
We conducted a comprehensive search of Medline, EMBASE, CINAHL, and Cochrane databases to identify studies of dispatcher stroke recognition accuracy. Those that specifically reported dispatcher utilization of any validated stroke screening tools in isolation or in the context of a comprehensive screening algorithm such as the Medical Priority Dispatch System (MPDS) were potentially eligible. Studies that reported data sufficient for calculation of dispatcher sensitivity or positive predictive value (PPV) using a hospital-based stroke/transient ischemic attack diagnosis as the reference standard were included. Two independent reviewers determined study eligibility, assessed quality using the QUADAS 2 instrument, and abstracted data.
We identified 1,413 potential studies; 54 underwent full text review. Three retrospective and 4 prospective cohort studies enrolling a total of 16,382 patients met the inclusion criteria. Stroke screening tools included MPDS (n = 4), Face Arm Speech Time (n = 2), and a novel screening algorithm developed after analysis of emergency calls for stroke (n = 1). Regardless of the screening tool employed, dispatcher stroke recognition sensitivity was suboptimal (5 studies, range 41-83%) as was the PPV (7 studies, range 42-68%). Primary study limitations included application of variable reference standards and questions regarding exclusion of subjects. No studies directly compared stroke screening algorithms and no studies specifically examined stroke recognition among potential candidates for acute stroke therapies.
Even when utilizing a stroke screening tool, the accuracy of stroke recognition by emergency dispatchers was suboptimal. More research is needed to identify the causes of poor dispatcher stroke recognition and should focus on potential candidates for time-dependent stroke treatment.
急救调度员是启动急性卒中应急响应的患者的首个接触点。调度员对卒中的准确识别与更快的紧急医疗服务响应时间相关；然而，在最初的紧急呼叫中，卒中常常未被识别。诸如辛辛那提院前卒中量表等卒中筛查工具已被证明可提高现场卒中识别率，因此被提议作为提高调度员准确性的一种手段。我们对使用卒中筛查工具时急救调度员卒中识别的准确性进行了系统评价。
我们对Medline、EMBASE、CINAHL和Cochrane数据库进行了全面检索，以确定有关调度员卒中识别准确性的研究。那些专门报告调度员单独使用任何经过验证的卒中筛查工具或在诸如医疗优先调度系统（MPDS）等综合筛查算法背景下使用该工具的研究可能符合条件。纳入那些以基于医院的卒中/短暂性脑缺血发作诊断作为参考标准，报告的数据足以计算调度员敏感性或阳性预测值（PPV）的研究。两名独立的评审员确定研究的合格性，使用QUADAS 2工具评估质量，并提取数据。
我们识别出1413项潜在研究；54项进行了全文审查。3项回顾性研究和4项前瞻性队列研究共纳入16382例患者，符合纳入标准。卒中筛查工具包括MPDS（n = 4）、面臂言语时间（n = 2）以及在分析卒中紧急呼叫后开发的一种新型筛查算法（n = 1）。无论采用何种筛查工具，调度员卒中识别的敏感性都不理想（5项研究，范围为41%-83%），PPV也是如此（7项研究，范围为42%-68%）。主要的研究局限性包括应用了可变的参考标准以及关于排除受试者的问题。没有研究直接比较卒中筛查算法，也没有研究专门检查急性卒中治疗潜在候选者中的卒中识别情况。
即使使用卒中筛查工具，急救调度员对卒中的识别准确性仍不理想。需要更多研究来确定调度员卒中识别不佳的原因，并且应关注时间依赖性卒中治疗的潜在候选者。
