Spotlight on Research

John Talbot
January 2016

Stroke recognition instruments: a systematic reviewWith the advent of stroke centres and the increasing use of reperfusion therapies in stroke management, the need to correctly identify strokes in a timely manner is vital in reducing subsequent patient mortality and morbidity.This highly detailed systematic review sought to establish the superiority, or otherwise, of validated stoke recognition instruments such as: ROSIER (Recognition of Stroke in the Emergency Room), LAPSS (Los Angeles Prehospital Stroke Screen) and FAST (Face Arm Speech Test). The review searched MEDLINE and EMBASE up to 10 August 2015, with no time or study design restrictions, and included abstracts from conference proceedings provided they were published in peer-reviewed journals.The reviewers, having begun with 5 622 papers, ultimately reviewed 21 publications (18 papers and 3 abstracts) containing seven stroke recognition instruments. Each was assessed for study population, instrument design, sensitivity, specificity, and where possible, negative and positive predictive values. Additional analysis sought to establish bias and additional cofounders.The review provides a rich and informative data set, easily accessible via two tables. A well written discussion raises thoughtful and interesting limitations to all seven instruments and ultimately suggests that no instrument demonstrates superiority. Indeed, those interested in delving beneath the statistical evidence which can, on the surface, appear impressive, will find much to admire in the forensic nature by which the researchers unpack the limitations of each stroke recognition instrument.This is an excellent review, one which posits many questions concerning the assessment of potential stroke patients, particularly in the pre-hospital setting. The fact that the paper does not reach a positive conclusion is arguably a strength and should not deter those interested in this particular condition.

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