Methods for improving the identification of acute stroke during ambulance calls: A scoping review

Abstract

Background: Accurately identifying strokes during ambulance calls remains challenging, leading to low diagnostic accuracy and delays in dispatching appropriate services. Limited evidence exists regarding methods for improving call handlers' stroke recognition. This scoping review explores methods for enhancing stroke identification during emergency calls in ambulance control centres (ACCs).

Methods: We conducted a scoping review following the methodology of the Joanna Briggs Institute and adhered to PRISMA-ScR guidelines. A systematic search was performed across five databases: Embase, Medline, Scopus, Web of Science, and CINAHL, also grey literature sources, covering publications from January 1964 to July 2024. We included studies that examined methods to improve stroke identification during emergency calls in ACCs. To assess the effectiveness of these methods, eligible studies must evaluate at least one of the following outcomes: accuracy of stroke diagnosis, time to diagnosis, effectiveness of staff training, and acceptability of identification techniques. Two reviewers independently screened the studies, extracted the data, and conducted an inductive thematic analysis to identify common themes.

Results: Of the 3,619 studies identified, seven met the inclusion criteria. Included studies focused on technology and algorithms (n = 3), training and educational programs (n = 2), and improved triage tools (n = 2) to enhance stroke identification during emergency calls to ACCs. Studies on technology and algorithms have reported increased stroke identification sensitivity and positive predictive value (PPV) when using new algorithms compared to standard protocols. Training programs have led to improved dispatcher sensitivity in stroke recognition. Improved triage tools also reduce time-to-diagnosis and facilitate quicker emergency responses.

Conclusion: This review highlights several methods for improving stroke identification in ACCs. Despite improvements in PPV, sensitivity, and diagnosis time, the lack of generalised standards, single-centre studies, and various population characteristics hinder broader impact. Future research should prioritise well-designed studies with standardised benchmarks to determine effectiveness, enabling effective prehospital stroke identification strategies.

Fig 1. Stroke chain of survival: critical steps required for optimal care, from emergency call to rehabilitation.

ED, emergency department. CT, computed tomography.

Fig 2. PRISMA flow chart. NHS, National Health Service. WHO, World Health Organisation, AHA, American Heart Association, MENA, National Emergency Number Association, IAED, International Academies of Emergency Dispatch. WOS, Web of Science. CINAHL, Cumulative Index to Nursing and Allied Health Literature.