Background: 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. Methods: 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. Results: 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. Conclusion: 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.

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tion. IVUS extends a measure of quality control that directs optimal balloon and stent sizing. Adjunctive IVUS use identifies suboptimal initial stent expansion and guides additional balloon angioplasty. Use of IVUS does not increase neurologic events. IVUS should be considered an important component of advanced endovascular procedures such as CAS.

Introduction: Emergency dispatchers are usually the first contact point for stroke patients accessing the healthcare system. Dispatcher stroke recognition is associated with better paramedic stroke recognition and faster emergency medical services (EMS) response time, but stroke is often unrecognized during the initial call. We conducted a systematic review to quantify the accuracy of emergency dispatcher stroke recognition when employing stroke screening tools. Methods: We conducted a comprehensive search Medline, EMBASE, CINAHL, and Cochrane databases to identify studies of dispatcher stroke recognition accuracy using a stroke screening tools such as the Medical Priority Dispatch System (MDPS) or Face Arm Speech Time (FAST) mnemonic. Studies were included if they reported dispatcher sensitivity or positive predictive value (PVP) using hospital stroke/TIA diagnosis as the gold standard. Study quality was assessed using QUADAS 2. Two independent reviewers determined study eligibility, assessed quality, and abstracted data. Results: We identified 1450 abstracts; seven cohort studies met inclusion criteria. Stroke screening tools included MPDS (n=4), FAST (n=2), and a novel screening algorithm (n=1). The sensitivity of dispatcher stroke recognition (5 studies, range 41-83%) and PPV (7 studies, range 42% -68%) were variable. Specificity was high (3 studies, 95-99%). No screening tool demonstrated superiority. Included studies had moderate risk of bias and dramatically variable stroke prevalence (range 3-68%). Conclusion: Published reports of screening tools utilized by emergency dispatchers demonstrate suboptimal sensitivity and PPV. More research is needed to identify the causes of poor dispatcher stroke recognition and to improve stroke screening tools.

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