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. 2019 Jul 17:11:147-159.
doi: 10.2147/OAEM.S178544. eCollection 2019.

The role of the Cincinnati Prehospital Stroke Scale in the emergency department: evidence from a systematic review and meta-analysis

A De Luca #  1 , M Mariani #  2 , M T Riccardi  2 , G Damiani  2   3
Affiliations

The role of the Cincinnati Prehospital Stroke Scale in the emergency department: evidence from a systematic review and meta-analysis

A De Luca et al. Open Access Emerg Med. .

Abstract

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: diagnostic accuracy; emergency department; emergency medical services; healthcare; stroke; triage.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram of included studies. Abbreviations: WOS, Web of Science; TP, true positives; TN, true negatives; FP, false positives; FN, false negatives.
Figure 2
Figure 2
Stacked bar charts of Revised Quality Assessment of Diagnostic Accuracy Studies -2 (QUADAS-2) scores, presenting a quick overview of the methodological quality of the 18 included studies expressed as a percentage of studies that met each criterion.
Figure 3
Figure 3
Data from meta-analyzed studies and forest plot for sensitivity and specificity of Cincinnati Prehospital Stroke Scale. Abbreviations: TP, true positives; FP, false positives; FN, false negatives; TN, true negatives.
Figure 4
Figure 4
Summary receiving operating characteristic (sROC) curve.
See this image and copyright information in PMC

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