Evaluation of the Recognition of Stroke in the Emergency Room (ROSIER) Scale in Chinese Patients in Hong Kong

Jiang, Hangjin; Chan, Cangel Pui-yee; Leung, Yuk-ki; Li, Yunmei; Graham, Colin A.; Rainer, Timothy

doi:10.1371/journal.pone.0109762

Cited by 20 publications

(18 citation statements)

References 33 publications

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“…For the critical outcome of time to treatment, we identified 6 studies with 6 different stroke assessment systems studied: For the important outcome of recognition of stroke (diagnostic studies, outcome defined as correct stroke diagnosis), we identified low-quality evidence (all downgraded for risk of bias) from 22 observational studies 44,[46][47][48][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] enrolling a total of 30 635 patients, studying 8 different stroke screening assessment systems, showing diagnostic performance across all stroke screening systems of sensitivity ranging from 0.41 to 0.97 and specificity ranging from 0.13 to 1.00. These studies were divided into subgroups based on whether the stroke scales included glucose measurement or not.…”

Section: Consensus On Sciencementioning

confidence: 99%

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Part 9: First Aid

Em¹,

Da²,

Buck³

et al. 2015

Circulation

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and curriculum development, and a specialist in first aid evidence evaluation methodology and guideline development.The task force convened in June 2013 to review the topics and questions that were evaluated in 2005 and 2010, past research questions formulated in the PICO style (population, intervention, comparator, outcomes) that were never completed, and the new questions that had been submitted since 2010 to the task force, and a priority list created. Topics were reviewed for areas of controversy, known additional new science, and subject matter not previously evaluated. Task force members created a priority list for review, and the top 10 priority-ranked PICO questions were assigned. After the successful commencement of the workflow, the task force co-chairs added a further 12 PICO questions, including 5 new questions, 1 derived question, and 6 that had been previously reviewed. Selected PICO questions that had been previously reviewed were, in some cases, reworded to facilitate literature searches, and outcomes were decided upon by group consensus.Evidence reviewers were recruited through a call for volunteers distributed by ILCOR to stakeholder organizations around the world. More than 30 individual reviewers were assigned to topics, usually by preference or expertise, but avoiding any direct conflicts of interest. In general, 2 evidence reviewers were assigned to each PICO, supervised by a member of the task force designated as the task force question owner. Evidence reviewers included physicians with diverse specialties including emergency medicine, EMS, wilderness medicine, critical care, cardiology, occupational medicine, toxicology, anesthesia, pediatric emergency medicine, public health, and epidemiology, as well as paramedics, nurse practitioners and first aid education specialists with experience in guideline and curriculum development, and professional evidence evaluation and methodology experts. The Evidence Evaluation ProcessFor the 2015 international evidence evaluation process, the AHA developed a new Web-based information and documentation platform, the Systematic Evidence Evaluation and Review System (SEERS), to support the ILCOR systematic reviews and to capture the data in reusable formats. This Webbased system facilitated structured reviews in a consistent format that would support the ultimate development of science summaries and evidence-based treatment recommendations.Each task force performed a detailed systematic review based on the recommendations of the Institute of Medicine of the National Academies, 1 using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group.2 After identifying and prioritizing the PICO questions to be addressed, 3 and with the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evalu...

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Section: Consensus On Sciencementioning

confidence: 99%

“…Two additional studies were added 51,59 and incorporated into the consensus on science and GRADE tables, both supporting this treatment recommendation.…”

Section: Treatment Recommendationmentioning

confidence: 99%

Part 9: First Aid

Em¹,

Da²,

Buck³

et al. 2015

Circulation

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“…Eleven other scales were used in one study each: National Stroke Project Stroke Scale, Oxford Handicapped Scale, Chinese National Scoring Criteria for Neurological Deficits in Patients with Stroke, Orpington Prognostic Scale, Fugl‐Meyer Assessment of Motor Recovery, Stroke Levity Scale, Functional Independence Measure, New Zealand Clinical Guidelines for Stroke Management, and New Zealand Guideline For the Assessment and Management of People with Recent Transient Ischemic Attack (TIA) . One study used a neuropsychological battery, which included assessments like digit span and the Boston Naming Test .…”

Section: Resultsmentioning

confidence: 99%

Classification of Mild Stroke: A Mapping Review

Schwartz

Capó-Lugo

Akinwuntan

et al. 2019

PM&R

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Persons with mild stroke experience motor and cognitive impairments that negatively affect their health and quality of life. To address these deficits, it is essential for clinicians and researchers to precisely identify mild stroke survivors. Despite the fact that half of all strokes are categorized as mild, no standards exist on what constitutes a “mild” stroke. The purpose of this study is to summarize the current classification of mild stroke using a mapping review approach. Strategies to categorize “mild stroke” severity were explored in 188 papers indexed in the PubMed database. The results indicate that there was substantial variability in the procedures and scoring criteria used to determine mild stroke. To identify persons with mild stroke, researchers have largely applied assessment instruments developed to inform acute stroke care (eg, National Institutes of Health Stroke Scale, Modified Rankin Scale, Barthel Index). Unfortunately, these approaches demonstrate floor effects and fail to detect the long‐term disabling impairments that often limit the outcomes of mild stroke survivors. Additional research is warranted to suggest an evidence‐based mild stroke categorization strategy that enhances diagnosis, treatment, and referral decisions to the benefit of mild stroke survivors.

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“…There were some new items added in GZSS based on the analysis. In our previous study, we found that the level of consciousness of patients may affect the diagnostic value of the stroke screening scales [ 2 , 6 , 7 ]. Therefore, we assessed the diagnostic value of GCS in patients with suspected stroke.…”

Section: Discussionmentioning

confidence: 99%

“…LAPSS consists of four history items, a blood glucose measure, and three examination items designed to detect unilateral motor weakness [ 2 – 5 ]. However, our previous study demonstrated these three stroke scales were not effective for differentiating stroke from stroke mimics in Chinese settings [ 6 , 7 ]. The reasons may be related to the difference in factors affecting the incidence of stroke subtypes and stroke mimic in different ethnic populations [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Development of a new stroke scale in an emergency setting

Mao

Pan

et al. 2016

BMC Neurol

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BackgroundEarly identification of stroke is crucial to maximize early management benefits in emergency departments. This study aimed to develop and validate a new stroke recognition instrument for differentiating acute stroke from stroke mimics in an emergency setting.MethodsA prospective observational cohort study among suspected stroke patients presenting to Emergency Department in the Second Affiliated Hospital of Guangzhou Medical University was conducted from May 2012 to March 2013. The symptoms and signs of suspected stroke patients were collected. Logistic regression analysis was used to identify the factors associated with acute stroke. The symptoms and signs closely associated with acute stroke were selected to develop the new stroke scale, Guangzhou Stroke Scale (GZSS). The diagnostic value of GZSS was then compared with ROSIER, FAST and LAPSS. The primary outcome was confirmed stroke by CT within 24 h.ResultsFour hundred and sixteen suspected stroke patients (247 ischemia, 107 hemorrhage, 4 transient ischemic attack, 58 non-stroke) were assessed. A new stroke scale, GZSS (total score from −1 to 8.5), was developed and consisted of nine parameters: vertigo (−1), GCS ≤ 8 (+2), facial paralysis (+1), asymmetric arm weakness (+1), asymmetric leg weakness (+1), speech disturbance (+0.5), visual field defect (+1), systolic blood pressure ≥145 mmHg (+1) and diastolic blood pressure ≥95 mmHg (+1). Among the four scales, the discriminatory value (C-statistic) of GZSS was the best (AUC: 0.871 (p < 0.001) when compared to ROSIER (0.772), LAPSS (0.722) and FAST (0.699). At an optimal cut-off score of >1.5 on a scale from −1 to 8.5, the sensitivity and specificity of GZSS were 83.2 and 74.1 %, whilst the sensitivities and specificities of ROSIER were 77.7 and 70.7 %, FAST were 76.0 and 63.8 %, LAPSS were 56.4 and 87.9 %.ConclusionGZSS had better sensitivity than existing stroke scales in Chinese patients with suspected stroke. Further studies should be conducted to confirm its effectiveness in the initial differentiation of acute stroke from stroke mimics.

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Evaluation of the Recognition of Stroke in the Emergency Room (ROSIER) Scale in Chinese Patients in Hong Kong

Cited by 20 publications

References 33 publications

Part 9: First Aid

Part 9: First Aid

Classification of Mild Stroke: A Mapping Review

Development of a new stroke scale in an emergency setting

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