The value of predictive instruments in the screening of acute stroke: an umbrella review on previous systematic reviews

Abstract

Objective: Although various predictive instruments have been introduced for early stroke diagnosis, there is no consensus on their performance. Therefore, we decided to assess the value of predictive instruments in the detection of stroke by conducting an umbrella review.
 Methods: A search was performed in the Medline, Embase, Scopus and Web of Science databases by the end of August 2021 for systematic reviews and meta-analyses. Original articles included in the systematic reviews were retrieved, summarized and pooled sensitivity, specificity and diagnostic odds ratio were calculated. The level of evidence was divided into five groups: convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV) and non-significant.
 Results: The value of 33 predictive instruments was evaluated. The sample size included in these scoring systems’ assessments varied between 182 and 47072 patients. The level of evidence was class I in one tool, class II in 18 tools, class III in 2 tools, class IV in 11 tools, and non-significant in one tool. Apart from Med PACS, which had a low diagnostic value, other tools appeared to be able to detect a stroke. The optimum performance for diagnosis of stroke was for ROSIER, NIHSS, PASS, FAST, LAMS, RACE and CPSS.
 Conclusion: Convincing to suggestive evidence shows that ROSIER, NIHSS, PASS, FAST, LAMS, RACE and CPSS have the optimum performance in identifying stroke. Since ROSIER’s calculation is simple and has the highest sensitivity and specificity among those predictive instruments, it is recommended for stroke diagnosis in pre-hospital and in-hospital settings.

The Rapid Arterial oCclusion Evaluation (RACE) scale accuracy for diagnosis of acute ischemic stroke in emergency department – A multicenter study

“…Therefore, various interventions have been considered and applied by health care systems during the last decades to reduce the time between AIS onset and starting an appropriate management [7][8][9]. One of the most important measures was the reduction of wasting time both at the pre-hospital phase and also after admission to the emergency department (ED) [10,11]. Several stroke screening tools have been designed in this regard that can accurately predict stroke [11], that mostly applied in prehospital setting and their performance has been rarely evaluated in ED environment.…”

A nomogram-based clinical tool for acute ischemic stroke screening in prehospital setting

“…These tests often emphasize on avoidance of misdiagnosis of AIS cases, so their sensitivity is highlighted more, while the low specificity can lead to over-triage, overload of stroke centers, and wasting the resources. 3 - 6 We believe that designing a new tool that is comparable in terms of both sensitivity and specificity may play an important role in rapid and more accurate diagnosis of AIS in prehospital stage. Therefore, we intended to develop a new clinical tool for the diagnosis of AIS in the prehospital stage.…”