De Luca A, Mariani M, Riccardi M T, Damiani G
Istituti Fisioterapici Ospitalieri, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Open Access Emerg Med. 2019 Jul 17;11:147-159. doi: 10.2147/OAEM.S178544. eCollection 2019.
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.
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).
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).
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.
在高收入国家，中风是发病、致残和死亡的主要原因之一。早期的院前中风识别起着至关重要的作用，因为大多数临床决策应在症状出现后的最初几小时内做出。辛辛那提院前中风量表（CPSS）是一种经过验证的筛查工具，建议在分诊时使用。本研究的目的是通过评估CPSS在院前和医院环境中的敏感性和特异性，来回顾其作用。
对报告疑似中风患者中CPSS敏感性和特异性的文献进行系统综述和荟萃分析。检索截至2018年12月的电子数据库，并使用修订后的诊断准确性研究质量评估-2（QUADAS-2）进行质量评估。
荟萃分析纳入了11项研究。结果显示总体敏感性为82.46%（95%置信区间[CI]74.83-88.09%），特异性为56.95%（95%CI41.78-70.92）。当由医生（80.11%，95%CI66.14-89.25%）或非医生（81.11%，95%CI69.78-88.87%）执行CPSS时，在敏感性方面未发现显著差异。然而，与非医生执行（50.07%，95%CI31.54-68.58%）相比，医生执行时特异性更高（73.57%，95%CI65.78-80.12%）。前瞻性研究显示特异性为71.61%（95%CI61.12-80.18%），敏感性为86.82%（95%CI74.72-93.63），而回顾性研究显示特异性为33.37%（95%CI22.79-45.94%），敏感性为78.52%（95%CI75.08-81.60）。
CPSS是一种标准化且易于使用的中风筛查工具，建议将其纳入紧急系统协议，并与地方、区域和州机构、医疗当局及当地专家进行适当且一致的协调。
